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Research Title: Tear film biomarker in Traumatic Brain Injury (TBI)

Supervisors: Associate Professor Maria Markoulli, Emeritus Professor Eric Papas

Research Abstract: Traumatic brain injury (TBI) is a sudden insult to the brain from an external mechanical force that may result in permanent or temporary impairment of cognitive, physical and psychosocial functions, with an associated diminished or altered state of consciousness that is not degenerative. Dubbed the "silent epidemic", TBI is a leading cause of disability and death worldwide. It can occur in all age groups, but children, young adults and the elderly are particularly vulnerable. Falls, motor vehicle accidents, violence, sports activities, and blasts from military operations in war zones are among the major causes of TBI.
Globally, it is estimated that between 54 and 69 million TBI occur each year, and at least 10 million people are hospitalised or die annually from this condition, placing a burden on public health resources worldwide. The total cost of TBI has been estimated at AUD 8.6 billion and USD 76.5 billion in Australia and the United States respectively.
The mechanism of TBI is a severe cascade of primary and secondary injuries affecting not only neural tissue but also other organs. Excitotoxicity, neuroinflammation and cytokine damage, oxidative damage and eventual cell death are prominent mechanisms of cell damage following TBI. TBI can cause physical, cognitive, social, emotional, and behavioural effects, with an unpredictable prognosis ranging from full recovery to permanent disability or death. There is a growing awareness of the potential long-term consequences of brain injury, such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis.
The eyes and surrounding structures can be severely affected by TBI, although a possible association between neurotrauma and ocular surface biomarkers has received little attention in the scientific literature. We hypothesise that since TBI is a condition that affects the functioning of the brain, it will also affect the ocular surface and this will be reflected in the concentration of tear film proteins.
TBI biomarkers have been explored extensively in many bodily tissues and fluids, but relatively little attention has been paid to the tear film and ocular surface. The tear film can reflect the status of the ocular surface and systemic diseases and is easily accessible for collection and analysis. It is, therefore, of interest to investigate the role of specific biomarker in the tear film in both health and disease. This thesis aims to investigate the role of specific tear biomarker in TBI patients and non-TBI controls.
Hypothesis: The composition of the tear film changes following the occurrence of TBI.