Purpose: To evaluate the contribution of three mechanisms-evaporation of the tear film, inward flow of water into the corneal epithelium or contact lens, and "tangential flow" along the surface of epithelium or contact lens-to the thinning of the tear film between blinks and to tear film break-up. In addition to a discussion of relevant studies, some previously unpublished images are presented illustrating aspects of tear film break-up. CONTRIBUTIONS OF THREE MECHANISMS TO TEAR FILM BREAK-UP: Inward flow of water into the epithelium or contact lens is probably unimportant, and a small flow in the opposite direction may actually occur. Tangential flow is probably important in certain special cases of tear film break-up-at the black line near the tear meniscus, over surface elevations, after partial blinks, and from small thick lipid spots in the tear film. In all these special cases it is argued that tangential flow is important initially, but evaporation may be needed for final thinning to break-up. It is argued that most of the observed tear film thinning between blinks is due to evaporation, rather than tangential flow, and that large "pool" break-up regions are the result of evaporation over an extended area.
Conclusion: Evaporation in our "free-air" conditions may be four to five times faster than the average of the values reported in the literature when air currents are prevented by preocular chambers. However, recent evaporation measurements using "ventilated chambers" give higher values, which may correspond better to free-air conditions. Thus evaporation may be fast enough to explain many cases of tear film break-up, and to give rise to considerable increases in the local osmolarity of the tear film between blinks.