Abstract
PurposeAssess potential risk factors for severe Meibomian gland atrophy (SMGA) in a young adult population.MethodsCross-sectional study using medical history and ocular surface examination to evaluate relationships with study outcomes: SMGA, tear lipid layer (TLL) thickness, non-invasive (NITBUT) and fluorescein (FTBUT) tear breakup times, and symptoms using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire.ResultsOne hundred one participants (101; 202 eyes; Age: mean±SD = 22.3±4.0 years) completed the study. Hormonal birth control (HBC) use was the only significant risk factor for SMGA (p = 0.028). Female HBC users had 4.8 times greater odds of having SMGA compared to female HBC non-users (p = 0.028), but the odds of having SMGA was similar between female HBC non-users and males (p = 0.885). Multivariable analysis suggested that the relationship between SMGA and TLL thickness was dependent on HBC use. Compared to female HBC non-users without SMGA, TLL thickness for HBC users was estimated to be 10 nm thinner if SMGA was absent (p = 0.007) and 21 nm thinner if SMGA was present (p<0.001). SMGA status had no significant impact on TLL thickness among female HBC non-users (p = 0.552). The effect of TLL thickness on FTBUT was small but significant (p = 0.026). TLL thickness was not significantly associated with NITBUT (p = 0.349). Neither FTBUT nor NITBUT was significantly associated with the SPEED score.ConclusionHBC use may be associated with SMGA, supporting the hypothesis that SMGA could lead to thinner TLL. However, less evidence was present to support that thin TLL could lead to clinically detectable tear film instability and subsequently to increased ocular dryness symptoms. Further investigation with a larger sample size is warranted to confirm these findings.
Highlights
Lipids secreted from Meibomian glands are considered the main component of the superficial lipid layer of the tear film that protects the aqueous phase from evaporation and stabilizes the tear film by lowering surface tension [1,2]
Female Hormonal Birth Control (HBC) users had 4.8 times greater odds of having severe Meibomian gland atrophy (SMGA) compared to female HBC non-users (p = 0.028), but the odds of having SMGA was similar between female HBC non-users and males (p = 0.885)
Multivariable analysis suggested that the relationship between SMGA and tear lipid layer (TLL) thickness was dependent on HBC use
Summary
Lipids secreted from Meibomian glands are considered the main component of the superficial lipid layer of the tear film that protects the aqueous phase from evaporation and stabilizes the tear film by lowering surface tension [1,2]. Studies have reported that Meibomian gland atrophy was associated with thinner tear lipid layer [6,7,8,9,10] Of these studies, only one reports significant relationships between shorter tear breakup time and either thinner tear lipid layers or increased symptoms[10]. Only one reports significant relationships between shorter tear breakup time and either thinner tear lipid layers or increased symptoms[10] These discrepancies do not provide convincing evidence that alterations in the oil glands will be reflected downstream in tear film stability or symptoms. Conflicting results could be due to differences in study population, sample size, or instrumentation These studies did not control for potential confounders in their analyses [6,7,8,9,10]. Both endogenous factors, such as age and sex, as well as exogenous factors, such as medications (e.g., hormonal birth control (HBC), anti-allergy, and antidepressants) and contact lenses are believed to influence one or many of the abovementioned ocular surface parameters [5,11]
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