A central clinical measure in the diagnosis and evaluation of dry eye disease is the tear film breakup time (BUT). Traditionally, its measurement has relied on the instillation of sodium fluorescein and subjective evaluation of the tear film breakup time using the slit lamp biomicroscope. More recently, a shift towards a more noninvasive measure of BUT has enabled more reliable and repeatable measurement of tear film quality and ocular surface integrity. Automated measures of noninvasive breakup time (NIBUT), typically performed using a keratography-based device with infrared illumination, have now become the closest we have to a gold standard method of tear film breakup time measurement.
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