Phenol Red Thread-based Sampling Procedure for Untargeted Tear Fluid Lipidomics in Biomarker Discovery

Tear lipids are crucial for tear film stability and ocular surface health. Changes in tear composition could be associated with ocular and systemic diseases such as meibomian gland dysfunction and dyslipidemia. Profiling tear lipids may help biomarker discovery for disease diagnosis and management. However, common tear sampling methods present distinct limitations: Schirmer's strips frequently cause ocular irritation and discomfort due to their large contact area with the eye surface, while microcapillary tube collection could yield low reproducibility due to operator variability, especially when performed by different personnel. These limitations might compromise the accuracy and consistency of lipidomic data. This study introduces a minimally invasive phenol red thread (PRT)-based sampling method optimized for tear lipidomics. The thin structure of PRT minimizes the risk of ocular irritation and allows rapid and gentle tear collection. This user-friendly and easy-to-perform method is suitable for subjects with reduced tear volume or lower tolerance for foreign body sensation, and it enables more reproducible sample collection by reducing operator-dependent variability. Tear lipids collected by PRT were extracted using an optimized methanol/methyl tert-butyl ether (MTBE) phase separation protocol and analyzed by high-resolution LC-Orbitrap-IQX MS/MS with LipidSearch software. The workflow identified more than 700 unique tear lipid species, each characterized by specific fatty-acid-derived product ions. These results indicate that PRT-based sampling provides robust lipid recovery for tear lipidomic analysis. This minimally invasive and reproducible approach offers a practical platform for clinical and experimental tear lipid research. Ultimately, this could also facilitate biomarker discovery and disease monitoring.