Abstract
PURPOSE: To demonstrate the application of scanning electron microscopy with energy-dispersive x-ray spectroscopy (SEM/EDS) for analyzing Schirmer strips for particle concentration, size, morphology, and type distribution. METHODS: A cross-sectional design was used. Patients were prospectively recruited from the Miami Veterans Affairs (VA) Healthcare System eye clinic, and they underwent a complete ocular surface examination. The size, type, and chemical composition of particulate matter on Schirmer strips (from the left eye) were analyzed using SEM/EDS. RESULTS: Schirmer strips from all 6 patients showed particle loading, ranging from 1 to 33 particles, whereas the blank Schirmer strip that served as a control showed no particle loading. Most particles were coarse, with an average size of 19.7 μm (95% confidence interval 15-24.4 μm). All samples contained organic particles (eg, pollen and mold), and 5 of the 6 samples contained nonorganic particles. The nonorganic particles were composed of silicon, minerals, and metals, including gold and titanium. The size of aluminum and iron particles was ≥62 μm, whereas the size of 2 other metals, zinc and gold, was smaller, that is, <20 μm. Most metal particles were elongated compared with the organic particles, which were round. CONCLUSIONS: Although SEM/EDS has been extensively used in biomedical research, its novel application to assess the size, morphology, and chemical composition of the ocular surface particles offers an unprecedented opportunity to tease out the role of particulate matter exposure in ocular surface disease and disorders.