All ETDs from UAB

Advisory Committee Chair

Kelly K Nichols

Advisory Committee Members

Amit Gaggar

Lawrence Sincich

Rabindra Tirouvanziam

Casey T Weaver

Mark D Willcox

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Optometry


Every night, during sleep, the tears of the closed eye become significantly more inflammatory, with a notable influx of neutrophils. Preliminary studies suggested that these neutrophils were significantly different than blood-isolated neutrophils, with an increased concentration, upregulated surface expression of inflammatory membrane receptors, but inability to respond to inflammatory stimuli. The purpose of this dissertation was to better understand the contribution of this neutrophil population to ocular surface homeostasis and dry eye disease. Chapter One presents an introduction to the tear film and ocular surface, along with an introduction to dry eye disease and neutrophil biology. Chapter One also discusses optimization of methods used in later chapters. In Chapter Two, the phenotype of closed eye neutrophils is observed with varying amounts of sleep, to show that neutrophil phenotype changes between one and seven hours of sleep. Chapter Threeinvestigates the relation of neutrophils in the closed eye, to that of the open eye. Chapter Four presents an investigation of leukocytes in the post-lens tear film of scleral contact lens wearers, to determine if this leukocyte population impacts clinical outcomes for these patients. Chapter Five continues the investigation in Chapter One, by comparing the closed eye neutrophil phenotype and degranulation response between normal and dry eye subjects. Chapter Six runs parallel to Chapter Five, to assess intracellular cytokine production in closed eye neutrophils. Chapter Seven presents a small-scale clinical trial for the assessment of an eyewash, immediately upon awakening, as a potential therapy for dry eye disease. Overall, the results from all chapters are discussed in Chapter 8, and future directions are presented.

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Optometry Commons