{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T20:32:05Z","timestamp":1771273925711,"version":"3.50.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011665","name":"Deanship of Scientific Research, King Saud University","doi-asserted-by":"publisher","award":["Cornea Research Chairs"],"award-info":[{"award-number":["Cornea Research Chairs"]}],"id":[{"id":"10.13039\/501100011665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To investigate the effect of the addition of a low concentration of sodium chloride (NaCl) and potassium chloride (KCl) solutions on the tear ferning (TF) patterns of tears collected from humans.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A tear sample (20 \u03bcL) was collected from the right eye of 23 males and 7 females (25.4 \u00b1 6.6 years). The tears were collected in one sitting for healthy subjects (<jats:italic>N<\/jats:italic> = 13). For dry eye participants (<jats:italic>N<\/jats:italic> = 17), the tear samples were collected in two separate settings with five minutes gap in between. A sample (1 \u03bcL) from each tear was dried on a glass slide, and the obtained ferns were observed using a microscope and graded using the five-point TF grading scale. Mixtures of tear samples (0.5 \u03bcL) and different volumes (0.5\u20132.5 \u03bcL) of each electrolyte (10\u201330 mg in 100 mL of water) solution were prepared, and their TF patterns were recorded and compared with those of the corresponding pure tears.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Significant improvements (Wilcoxon test, <jats:italic>P<\/jats:italic> &lt; 0.001) have been seen in the TF grades of the tear samples after the addition of NaCl and KCl solutions. A significant difference (Wilcoxon test, <jats:italic>P<\/jats:italic> = 0.016) was found between the TF grades when NaCl and KCl solutions were added to the tear samples. The TF grades of pure tears collected from dry-eye subjects ranged from 2.1 to 3.5, based on the five points grading scale, and decreased to be in the range of 0.4 to 1.6 after the addition of electrolyte solutions. While the TF grades of pure tears collected from normal-eye ranged from 1.2 to 1.9 and improved after the addition of electrolyte solution to be in the range of 0.4 to 1.5.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The TF test was used <jats:italic>in vitro<\/jats:italic> to assess the impact of the addition of a low concentration of sodium and potassium chloride solutions on tears collected from humans. The TF grades of human tears significantly improved after the addition of either sodium or potassium chloride solution. The mechanism for the improvement in TF grades due to the addition of electrolyte solutions must be investigated.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0280853","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T18:24:58Z","timestamp":1675448698000},"page":"e0280853","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of monovalent electrolyte solutions on the human tear ferning pattern"],"prefix":"10.1371","volume":"18","author":[{"given":"Essam S.","family":"Almutleb","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6675-3126","authenticated-orcid":true,"given":"Gamal A.","family":"El-Hiti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hesham A.","family":"Al-Dawas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed K.","family":"Alanzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alquwayi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah G.","family":"Alotaibi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mashaaer A.","family":"Baashen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basal H.","family":"Altoaimi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saud A.","family":"Alanazi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali M.","family":"Masmali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,3]]},"reference":[{"key":"pone.0280853.ref001","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1136\/bjophthalmol-2018-312333","article-title":"Effects of tear film dynamics on quality of vision","volume":"102","author":"S Koh","year":"2018","journal-title":"Br J Ophthalmol"},{"key":"pone.0280853.ref002","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II Definition and classification report.","volume":"15","author":"JP Craig","year":"2017","journal-title":"Ocul Surf."},{"key":"pone.0280853.ref003","doi-asserted-by":"crossref","unstructured":"The epidemiology of dry eye disease: Report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). 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