Abstract
Purpose To examine the morphological changes in the meibomian glands of patients with keratoconus as well as to study the relationship between these changes in the morphology and several tear film parameters. Methods Examination of the meibomian gland (MG) of 300 keratoconus patients presenting to the center using infrared noncontact meibography system (Sirius, CSO, Italy) between January 2017—January 2019. 100 eyes of healthy individuals were also enrolled as a control group. Tear breakup time (TBUT) test and Schirmer test II were evaluated. Subjective symptoms were also assessed using Ocular Surface Disease Index (OSDI). Results Mean age of keratoconus patients was 19 ± 12 years and 21 ± 14 years in control group. Average TBUT was 4.9 ± 2.1 sec. and average Schirmer test was 5.3 ± 2.2 mm which was significantly lower than control group (p=0.05). Meibomian gland dropout in the lower eyelid of the keratoconus group was as follows: grade 0 (no loss of meibomian glands): 100 eyes; grade 1 (gland dropout area <1/3 of the total meibomian glands): 85 eyes; grade 2 (gland dropout area 1/3 to 2/3): 68 eyes; and grade 3 (gland dropout >2/3): 47 eyes. Conclusion Keratoconus shows significant meibomian gland dropout and distortion that can be recorded by noncontact meibography. Sirius meibography is a simple, cost-effective method of evaluating meibomian gland dropout as a part of the routine refractive examination.
Highlights
Meibomian gland dysfunction (MGD) is considered the main cause of dry eye disease, leading to evaporative dry eye.e lipid layer in the tear film is derived mainly from the meibomian glands which are of utmost importance for preserving the ocular surface [1]
MGD-related dry eye can be diagnosed by indirect tests, such as tear breakup time (TBUT) [3] or by direct methods such as meibography, which is using transillumination or infrared (IR) light to image the Meibomian glands (MG) [4, 5]
KC group and the control group were age and sex matched with no statistical difference. e TBUT and Schirmer test indicated statistically significant differences between both groups with the lower values belonging to the KC group. e Ocular Surface Disease Index (OSDI) was significantly higher in the KC group than that in
Summary
Meibomian gland dysfunction (MGD) is considered the main cause of dry eye disease, leading to evaporative dry eye. E lipid layer in the tear film is derived mainly from the meibomian glands which are of utmost importance for preserving the ocular surface [1]. MGD-related dry eye can be diagnosed by indirect tests, such as tear breakup time (TBUT) [3] or by direct methods such as meibography, which is using transillumination or infrared (IR) light to image the MGs [4, 5]. Indirect tests are liable for a certain degree of interobserver or intraobserver error. The direct method gives detailed anatomic data of the meibomian glands [6]. MGD has some slit lamp characteristics as clogging of orifices with failure of expressibility of meibum, telangiectasia and hyperemia around the orifices, and thickening of the inner border of the lid margin [7]
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