Abstract
Purpose: The aim of this study was to use swept-source anterior segment optical coherence tomography (OCT) to explore imaging the meibomian gland openings and to identify their in vivo characteristics in patients with obstructive meibomian gland dysfunction (MGD) and healthy participants. Methods: We enrolled 49 patients with MGD and 54 health controls in this case-control study. Each participant underwent slit-lamp examination, meibography, and OCT scanning. Sixteen patients with MGD underwent a repeat OCT examination after eyelid massage. The outcome measures included determinations of meibomian gland openings (orifices and terminal ducts) from OCT images and comparisons of the meibomian openings between patients with MGD and normal controls before and after meibomian gland massage. Results: Using the same OCT scanning model, the number of visible orifices of the meibomian glands was similar between eyes with MGD and normal eyes (9.2 ± 2.3 vs. 9.7 ± 2.4). The mean diameter of the terminal ducts in patients with MGD was larger (120.22 ± 27.92 µm vs. 100.96 ± 20.30 µm) than in the normal controls, and had a larger coefficient of variation. Significant differences were observed in the mean diameter of the terminal ducts of patients with MGD before and after meibum gland massage (133.73 ± 27.81 μm vs. 102.26 ± 24.30 μm, p < 0.001). Conclusions: Patients with MGD have more diversified orifices and larger meibomian gland terminal duct diameters than normal subjects. In addition, meibomian gland terminal duct diameters seem to decrease in patients with MGD after meibum gland massage.
Highlights
Meibomian gland dysfunction (MGD) is characterized by functional abnormalities of the meibomian glands [1]
We measured the openings of meibomian glands in vivo with optical coherence tomography (OCT), and compared these measurements with hematoxylin and eosin (H&E)-stained lid margin slides
Four indexes were measured for description: (1) the length of orifice, (2) the length of the whole terminal duct, (3) the maximal inner diameter of terminal duct, and (4) the maximal outer diameter of terminal duct, which included the thickness of the glandular epithelium
Summary
Meibomian gland dysfunction (MGD) is characterized by functional abnormalities of the meibomian glands [1]. Slit-lamp measurements were the only method for evaluating the meibomian gland orifices in vivo. Noncontact infrared meibography is an effective method used to detect the morphology of meibomian glands, revealing abnormalities like dropout, distortion, shortening, and thickening [7]. IVCM is limited by its cross-sectional scanning mode and working distance, so the diameter of the terminal ducts of the meibomian gland is difficult to measure using IVCM. Optical coherence tomography (OCT) was introduced for the in vivo assessment of the morphology of the meibomian glands to provide depth information and enhanced visibility of the acini and duct, providing a fast and convenient method to quantitatively and volumetrically evaluate the meibomian glands [11,12]. To the best of our knowledge, no study has yet used OCT to determine meibomian gland opening, including the orifices and terminal ducts. The aim of the present study was to elucidate the anatomic details of meibomian gland openings based on OCT imaging, and to explore the changes in these openings after meibum gland massage
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