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2026 OMIG Abstract

POSTER PRESENTATION


Differences in Tear Sphingolipid Composition Across Dry Eye Disease Subtypes

Patricia Fuentes^1,2, Laura Beatriz Paule Jimenez^1,2, Anat Galor^1,2, and Nawajes Mandal³

¹Miami Veterans Administration Medical Center, Miami, Florida; ²Bascom Palmer Eye Institute, University of Miami, Miami, Florida; ³Departments of Ophthalmology, Anatomy and Neurobiology, University of Tennessee Health Sciences Center, Hamilton Eye Institute, Memphis, Tennessee

Purpose: To compare tear sphingolipid (SPL) profiles, including ceramides (Cer), sphingomyelins (SM), and monohexosylceramide (MHC), among clinically defined dry eye phenotypes, including aqueous tear deficiency (ATD), meibomian gland dysfunction (MGD), and pain-predominant dry eye.

Methods: 49 Veterans at the Miami Veterans Affairs (VA) eye clinic were examined. Demographics and medical history were self-reported. Ocular Surface Disease Index (OSDI) and 5-Item Dry Eye Questionnaire (DEQ-5) questionnaires were used to assess symptoms. All participants underwent a tear film and ocular surface examination. Dry eye phenotypes were assigned using the following criteria: ATD was defined by Schirmer <8mm, MGD was defined by preserved tear production (Schirmer > 8 mm) with at least one meibomian gland (MG) abnormality (MG quality > 2, MG dropout > 2, or MG plugging > 2), pain-phenotype was defined by OSDI > 23, DEQ-5 > 9 or pain score > 2, together with preserved ocular surface findings (Schirmer > 8mm, TBUT >5 seconds, and corneal staining < 2). Tear lipid samples were analyzed using targeted liquid chromatography-tandem mass spectrometry. Statistical analyses included nonparametric and parametric comparisons, as appropriate; p=0.05 was considered statistically significant. Values are reported as mean + SD.

Results: Of the 49 participants, there were 13 ATD, 27 MGD, and 9 pain-phenotype. In the entire population, the mean age was 57 years and 84% were male, without significant differences across the groups. As expected, Schirmer test results were lowest in the ATD group (6.1 mm) versus the MGD (18.89 mm) and pain (19.00 mm) groups while MG parameters were more severe in the MGD group compared to the other two groups (MG quality: ATD 1.36, MGD 2.15, pain 0.33; MG dropout: ATD 1.07, MGD 1.78, pain 0.67), p<.001 for all. However, DED symptoms (OSDI, DEQ-5) and other signs (TBUT, corneal staining, MG plugging) were similar across groups. SPL composition differed across groups. The ATD group had higher total Cer levels than the MGD group (460.18+445.80 vs 178.80+283.01pmol; p=.004) and a higher relative Cer composition (16.92+4.87% vs 11.52+2.80%; p<.001). In contrast, the relative proportion of total MHC was higher in the MGD group than in the ATD group (4.64+2.35% vs 2.38+0.83%; p<.001).The same pattern was noted when looking at SPL sub-species with the ATD group having higher levels of several Cer species (16:0, 18:1, 22:0, 24:1, 24:0, 26:1) compared to the MGD and pain phenotypes.

Conclusions: The ATD phenotype exhibited higher absolute tear Cer, as well as greater relative Cer composition, suggesting a more inflammatory tear lipid profile compared to the MGD and pain phenotypes.