Lid Margin Abnormality Research Articles

A comparative study on the lipid layer thickness analysis of medical staff before and after work.

To study the change of the lipid layer thickness analysis in medical staff (MS) before and after work, and to explore the significance of measuring lipid layer thickness (LLT) respectively in four quadrants. Ocular Surface Disease Index (OSDI) questionnaire and video display terminal using time for 55 MS were collected (the informed consent was obtained from all patients). Noninvasive tear break-up time, LLT, tear meniscus height (TMH), meibomian glands (MG) dropout, and blink pattern before and after work (worked for more than 4 h) of 110 eyes were measured by Gaush iDea Ocular surface analyzer. Lid margin abnormalities were evaluated by the slit-lamp microscopy. The average OSDI score of 55 MS was 25.68 ± 14.91. The average LLT of 110 eyes after work (65.12 ± 3.63 nm) was significantly reduced compared to before work (66.54 ± 4.16 nm), p < 0.05. The LLT in the superior quadrant was significantly thinner than that in the other three quadrants, p < 0.01. The average LLT was positively correlated with the LLT in the inferior (r = 0.822, p < 0.001), nasal (r = 0.261, p < 0.001), and temporal quadrant (r = 0.372, p < 0.001), while was negatively correlated with the MG dropout in lower lid (r = -0.209, p = 0.002). There was a significant correlation between the LLT in the inferior quadrant and the VDTt (r = -0.173, p = 0.01). The LLT of inferior quadrant were positively related to the TMH (r = 0.149, p = 0.027) and negatively related to MG dropout in lower lid (r = -0.162, p = 0.017). The LLT significantly decreases after work in MS. The distribution of the lipid layer on the ocular surface is uneven. It is unreasonable for current detection instruments to measure the inferior quadrant LLT alone to represent average LLT.

The Proportion of Ocular Involvement and Characteristics of Dry Eye Parameters in Primary Sjögren's Syndrome Referred from the Rheumatology Department.

To report the proportion of ocular involvement in primary Sjögren's syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear break-up time (TBUT), meibomian gland (MG) dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro Ab, anti-La Ab, ANA, RF, ESR, and CRP were included as systemic serum titers of markers. Patients with (Group 1) and without (Group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (74%) in group 1 and 31 (25%) in group 2. Group 1 showed higher meibum quality scores (p=0.016), meibum expressibility (p=0.01), and lid margin abnormalities on the lower lid (p=0.029) and lower TBUT (p=0.016) than group 2. Among the serum titers of markers, anti-Ro Ab negatively correlated with TBUT (r=-0.211, p=0.028). OSS, TBUT, and the schirmer test statistically differed between the patients who satisfied both ocular criteria (N=46) and those who satisfied only one criterion (N=41) (p=<0.001, 0.041, 0043, respectively). There were no statistical differences in serum titers of markers between the two groups. About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 74%, and half of these patients met both ocular criteria. Only anti-Ro Ab negatively correlated with TBUT. Also, OSS, TBUT, and schirmer test were statistically different between the two subgroups.

Evaluating the role of Demodex infestation and meibomian gland dysfunction in recurrent corneal erosion syndrome.

This investigation aims to observe the effects of demodex infection and meibomian gland function in recurrent corneal erosion syndrome (RCES), as well as the efficacy of intense pulsed light (IPL) in treating RCES. The study enrolled thirty patients diagnosed with RCES (30 eyes) alongside a control group of thirty-one individuals (31 eyes). Both cohorts underwent a series of diagnostic evaluations, including eyelash sampling, Demodex mite enumeration, infrared imaging of the meibomian glands, and blepharolipin scoring. The RCES subjects were further categorized into two subgroups upon stabilization for comparative analysis of treatment outcomes: the RCES-A subgroup received IPL therapy (16 patients), and the RCES-B subgroup was administered medication treatment (14 patients). Post-treatment, all participants were re-evaluated using the initial diagnostic procedures to monitor for recurrence. Preliminary findings indicated significant differences between the RCES and control groups in terms of meibomian gland scores (4 [3.0, 4.0] vs. 2 [1.0, 3.0]), blepharolipin scores (15.5 [11.0, 16.8] vs. 8.0 [5.5, 10.0]), and lid margin scores (3.0 [2.8, 3.0] vs. 2.0 [1.0, 3.0]), with P < 0.01 for all comparisons. Additionally, the Demodex count was significantly higher in the RCES group (8.0 [4.0,9.0]) compared to the control (0 [0, 2]) (Z = - 4.13, P = 0.00), with a Demodex positivity rate of 83.3% in the RCES group versus 38.7% in the control group (χ2 = 7.60, P < 0.01). Post-treatment, the RCES-A subgroup exhibited significant improvements in meibomian gland loss scores, blepharolipin scores, lid margin abnormality scores, and a reduction in Demodex counts (P < 0.01), with a post-treatment Demodex positivity rate of 56.3% (P = 0.11). During the follow-up, the RCES-A subgroup experienced a lower relapse rate compared to the RCES-B subgroup (1 vs. 6 patients). The findings suggest a correlation between meibomian gland dysfunction and Demodex infestation with the incidence of RCES. The application of IPL therapy in combination with meibomian gland massage demonstrates significant potential in enhancing meibomian gland functionality, reducing Demodex counts, and effectively mitigating the recurrence of RCES. Clinical trial registration: https://www.chictr.org.cn/ ChiCTR2000039494 (30/10/2020).

Epidemiology and risk factors for the development of cicatrizing conjunctivitis in chronic ocular graft-versus-host disease

PurposeTo evaluate the incidence of chronic cicatrizing conjunctivitis (CCC) and its associated risk factors in the context of chronic ocular graft-vs-host disease (coGVHD). MethodsA retrospective chart review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021 was performed. Data regarding baseline demographic characteristics, systemic co-morbidities, lid margin abnormalities, ocular cicatricial changes, transplant information, immunosuppressive therapy, and GVHD severity assessments were collected. The incidence of cicatricial conjunctivitis was estimated with Kaplan-Meier survival analysis. A Cox regression model was used to assess the contribution of demographic and systemic variables to the development of CCC. Results167 individuals were included (53.9 ± 14.7 years old; 60.5 % male). 65 individuals presented with features suggestive of CCC an average of 60.9 ± 53.8 months after HSCT, with 60-month and 120-month incidences of 29.3 % and 48.9 %, respectively. Multivariable analysis demonstrated that age younger than 50 at the time of the first eye visit was associated with a higher chance of CCC development (Hazard Ratio (HR): 2.14, 95 % Confidence Interval (CI): 1.16–3.97, p = 0.02). ConclusionClinically detected cicatrizing conjunctivitis is an ocular manifestation of coGVHD, with an incidence that increases over time. Younger individuals may be at higher risk for CCC development.

The effect of intense pulsed light combined with topical 0.05% Cyclosporin A eyedrops in the treatment of Sjögren’s syndrome related dry eye

ABSTRACT Objectives This study aimed to assess the effectiveness and safety of intense pulsed light (IPL) therapy plus topical 0.05% cyclosporine A (CsA) eye drops to treat Sjögren’s Syndrome-related dry eyes (SS-DE). Research design and methods In this prospective, randomized trial included, 60 individuals with SS-DE symptoms were randomized to receive topical eye drops containing either 0.1% sodium hyaluronate (Group S) or 0.05% CsA (Group C) plus IPL therapy. Before the first treatment (baseline), and at 12, 16, and 20 weeks after treatment commencement, we assessed the best corrected visual acuity (BCVA), the Ocular Surface Disease Index (OSDI) score, the Schirmer I test (SIT), noninvasive tear breakup time (NBUT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, lid margin abnormality, MG expressibility, and meibum quality. Results Both groups showed significant improvements in the OSDI, NBUT, CFS, MG expressibility, and meibum quality (all p < 0.05). Group C showed a greater increase in OSDI, NBUT, MG expressibility, and meibum quality (all p < 0.05). Moreover, SIT and lid margin abnormalities significantly improved in Group C (both p < 0.05), but not in Group S. Conclusion Treatment with 0.05% CsA eyedrops plus IPL therapy could significantly reduce the issues and physical discomfort of patients with SS-DE. Clinical Trial Registered on 20 July 2021, with the registration number ChiCTR2100049059.

Meibum Lipidomic Analysis in Evaporative Dry Eye Subjects.

Meibomian Glands (MG) are sebaceous glands responsible for the production of meibum, the main component of the Tear Film Lipid Layer (TFLL). The TFLL facilitates the spread of the tear film over the ocular surface, provides stability and reduces tear evaporation. Alterations in meibum composition lead to different ocular alterations like Meibomian Gland Dysfunction (MGD) and subsequent Evaporative Dry Eye (EDE). The aim of the present study was to investigate the composition and abundance of meibum lipids and their relationship with eyelid margin abnormalities, lipid layer patterns and MG status. The study utilizes a lipidomic approach to identify and quantify lipids in meibum samples using an Elute UHPLC system. This system considered all four dimensions (mass/charge, retention time, ion mobility and intensity) to provide the accurate identification of lipid species. Samples were categorized as healthy or low/no signs of alteration (group 1) or severe signs of alteration or EDE/MGD (group 2). The current investigation found differences in Variable Importance in Projection lipid abundance between both groups for the MGD signs studied. Changes in meibum composition occur and are related to higher scores in eyelid margin hyperaemia, eyelid margin irregularity, MG orifice plugging, MG loss and lipid layer pattern.

Contact lens wear and follow‐up and its association with signs and symptoms of meibomian gland dysfunction

AbstractIntroductionThis study investigated the equivocal association between contact lens (CL) wear and meibomian gland dysfunction (MGD) by comparing the morphological, functional and subjective outcomes of CL wearers versus control, non‐CL wearers. CL wearers were examined as two cohorts based on the annual attendance of follow‐up visits (FLU—attended these visits, whereas non‐FLU did not).MethodsHabitual logMAR visual acuity, invasive and non‐invasive tear break‐up time, Schirmer test, Efron grading scales, meibum quality score (MQS), meibum expressibility score (MES), meibomian gland (MG) loss, lid margin abnormalities and subjective dry eye (DE) symptoms were assessed.ResultsOf the 128 participants, 31 were in the FLU cohort, 43 were in the non‐FLU cohort and 54 were controls (mean ages: 22.2 ± 3.1, 23.0 ± 4.6 and 22.3 ± 3.5, respectively). Non‐FLU CL wearers had more symptoms than controls (3.7 ± 2.4 vs. 2.3 ± 2.1, p &lt; 0.01). Morphologically, FLU (16.9 ± 8.8%, p = 0.02) and non‐FLU (18.6 ± 11.3%, p = 0.001) had more MG loss than controls (11.2 ± 6.8%). Functionally, FLU (0.6 ± 0.7, p = 0.01) and non‐FLU (0.8 ± 0.9, p = 0.001) had worse MES than controls (0.2 ± 0.5). FLU and non‐FLU were both associated with corneal staining (odds ratio [OR] = 3.42, 95% CI: 1.16–10.11, p = 0.03 and OR = 5.23, 95% CI: 1.89–14.48, p = 0.001, respectively) and MG loss (OR = 10.47, 95% CI: 1.14–96.29, p = 0.04 and OR = 16.63, 95% CI: 1.96–140.86, p = 0.01, respectively). Non‐FLU CL wear was also associated with abnormal MQS (OR = 12.87, 95% CI: 1.12–148.41, p = 0.04), conjunctival staining (OR = 12.18, 95% CI: 3.66–40.51, p &lt; 0.001) and lid margin telangiectasia (OR = 3.78, 95% CI: 1.55–9.21, p = 0.003). MGD was three times more prevalent in CL wearers (12%) than in controls (4%).ConclusionsBoth CL‐wearing cohorts demonstrated significantly more MG abnormalities than controls though the difference was not clinically significant. Non‐FLU CL wearers had more DE symptoms. Non‐FLU CL wear is an independent predictor for more abnormalities than FLU CL wear, emphasising the importance of follow‐ups.

Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics, and Outcomes

To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD). Retrospective clinical cohort study. Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independent t tests, 1-way analysis of variances, and χ2 tests, as appropriate. 173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, P < .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, P < .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99, P < .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62, P < .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66, P < .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%, P=.04). Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.

Ophthalmic findings in patients with autosomal recessive lamellar ichthyosis due to TGM1 mutations in an isolated population

PurposeTo describe the ocular clinical characteristics of a group of Mexican patients with lamellar ichthyosis (LI) arising from TGM1 pathogenic variants.MethodsOphthalmological exploration, pedigree analysis and genetic screening were performed in patients with an established clinical diagnosis of lamellar ichthyosis from families located in a small community in the Southeast of Mexico.ResultsNine patients with LI in five families were identified. There were six affected females. All patients (9/9) demonstrated eye lid abnormalities with eight patients showing lid margin abnormalities. Madarosis was present in only three individuals and corneal scarring was documented in two. All nine individuals carried biallelic TGM1 variants, either homozygously or as compound heterozygous.ConclusionOcular anomalies are common in individuals with TGM1-related LI. The occurrence of a variety of private or rare mutations hampers the identification of a genotype–phenotype correlation for ocular anomalies in this disorder.

The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris.

The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3months after the start of therapy, and 1month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = -0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage.

Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis.

Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.

Association of meibomian gland morphology with orifice plugging and lid margin thickening in meibomian gland dysfunction patients.

We sought to investigate the association of meibomian gland morphology with lid margin abnormalities in patients with meibomian gland dysfunction. This retrospective study included 368 eyes of 184 patients. Meibography was used to evaluate meibomian gland (MG) morphological features, such as dropout, distortion, thickened ratio and thinned ratio. Lid margin photography was used to evaluate lid margin abnormalities including orifice plugging, vascularity, irregularity and thickening. The association between MG morphological features and lid margin abnormalities was analyzed using a mixed linear model. The study found a positive correlation between plugging of gland orifices grade and MG dropout grade in both the upper lids (B = 0.40, p = 0.007) and the lower lids (B = 0.55, p = 0.001). Plugging of gland orifices grade was also positively correlated to MG distortion grade in the upper lids (B = 0.75, p = 0.006). In the upper lids, MG thickened ratio increased first (B = 0.21, p = 0.003) and then decreased (B = - 0.14, p = 0.010) with a higher lid margin thickening grade. MG thinned ratio was negatively correlated with lid margin thickening (B = - 0.14, p = 0.002, B = - 0.13, p = 0.007). MG distortion grade decreased with lid margin thickening (B = - 0.61, p = 0.012). Orifice plugging was correlated to meibomian gland distortion and dropout. Lid margin thickening was associated with meibomian gland thickened ratio, thinned ratio, and distortion. The study also suggested that distorted and thinned glands may be transitional phases between thickened glands and glands dropout.

Combination therapy with 3% diquafosol tetrasodium ophthalmic solution and sodium hyaluronate: an effective therapy for patients with dry eye after femtosecond laser-assisted in situ keratomileusis.

To assess the effect of combination therapy with 3% diquafosol tetrasodium (DQS) and sodium hyaluronate (HA) for dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Prospective nonrandomized comparative trial. The prospective study included 80 eyes of 40 patients who underwent FS-LASIK with or without preoperative dry eye. Patients were divided into a combination group and a HA group according to their willingness and the doctor's advice. The combination group was treated with DQS six times a day and HA four times a day, and the HA group was treated with HA four times a day after FS-LASIK. Ocular surface disease index (OSDI), ocular symptom score, vision-related score, environmental score, tear meniscus height (TMH), first non-invasive tear breakup time (NIBUT-First), average non-invasive tear breakup time (NIBUT-Ave), tear breakup time (TBUT), Schirmer I test (SIT), corneal fluorescein staining score (CFS), bulbar redness score, limbal redness score, lipid layer grade (LLG), meiboscore, lid margin abnormality, corneal sensitivity, and corneal nerve parameters were examined before surgery and at 1 week and 1 month after surgery. Surface regularity index (SRI) was also examined before surgery and at 1 month postoperatively. OSDI score (p = 0.024) and vision-related score (p = 0.026) were significantly lower in the combination group than in the HA group at 1 month after FS-LASIK, especially in patients with preoperative dry eye symptoms. The increasements of CFS (p = 0.018), bulbar redness score (p = 0.021), and limbal redness score (p = 0.009) were significantly lower in the combination group than in the HA group at 1 week after FS-LASIK. But other ocular surface parameters showed no difference between both groups at 1 week and 1 month after FS-LASIK. LLG was significantly higher in the combination group than in the HA group at 1 week (p = 0.004) and 1 month (p < 0.001) after surgery, especially in patients with high meiboscore. Additional DQS significantly improved corneal sensitivity in patients without preoperative dry eye symptoms at 1 month after FS-LASIK (p = 0.041). The combination therapy with DQS and HA significantly relieved subjective symptoms, improved ocular surface status, and had the potential to promote corneal nerve growth in patients after FS-LASIK.

Binocular dynamic visual acuity in dry eye disease patients.

To investigate binocular dynamic visual acuity (DVA) for patients with dry eye disease (DED). The prospective study included DED patients. The binocular DVA at 40 and 80 degrees per second (dps), Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time first (TBUTF), corneal fluorescein staining (CFS), eyelid margin abnormalities and meibomian gland (MG) abnormalities morphology and function were evaluated. A deep learning model was applied to quantify the MG area proportion. The correlation between DVA and DED parameters was analyzed. A total of 73 DED patients were enrolled. The age, OSDI, CFS, MG expressibility, secretion quality, and eyelid margin abnormalities were significantly positively correlated with the DVA for 40 and 80 dps (all P < 0.05). The MG area proportion in the upper eyelid was negatively correlated with DVA at 40 dps (R = -0.293, P < 0.001) and at 80 dps (R = -0.304, P < 0.001). Subgroup analysis by MG grade demonstrated that the DVA of patients with severe MG dropout (<25% of the total area) was significantly worse than other mild and moderate groups, both in 40 and 80 dps (all P < 0.05). The patients with CFS showed worse 40 (P < 0.001) and 80 dps (P < 0.001) DVA than the patients without CFS. Binocular DVA is significantly associated with DED symptoms and signs. The DED patients with CFS and severe MG dropout and dysfunction have worse DVA.

Effect of Hypochlorous Acid on Blepharitis through Ultrasonic Atomization: A Randomized Clinical Trial.

To evaluate the efficacy and safety of eyelid hygiene using topical 0.01% hypochlorous acid (HOCL) through ultrasonic atomization after 2 weeks in patients with blepharitis. Randomized controlled trial. Patients with blepharitis were randomized into two groups: topical 0.01% HOCL through ultrasonic atomization (HOCL group, 42 eyes) or eyelid scrubs (control group, 37 eyes). Patients in both groups received warm compresses twice daily and topical 0.5% levofloxacin three times a day. Primary outcomes were the ocular surface disease index scores (OSDI), lid margin redness, lid margin abnormalities, meibum expressibility, meibum quality, and noninvasive breakup time after 2 weeks. Secondary outcomes were conjunctiva redness, corneal fluorescein staining, and tear meniscus height. A questionnaire of treatment adherence with a free response section was administered to confirm patient compliance and comments. Sixty-seven participants participated in this study. Both groups show an improvement in all primary outcomes, while statistically significant improvements in OSDI, lid margin redness, lid margin abnormality, meibum expressibility and quality are only limited to the HOCL group after 2 weeks of treatment (p < 0.05, p < 0.05, p < 0.001, p < 0.001 and p < 0.001, respectively). Subgroup analysis in HOCL reveals that only the change in lid margin abnormality and meibum expressibility in the mild-moderate meibomian glands loss patients at baseline has a statistically significant difference p < 0.05). Multiple linear regression shows that the improvement in OSDI is negatively associated with meibum expressibility score at the baseline (95% CI [-28.846, -1.815], p = 0.028). The patient compliance is 7.1 ± 2.0 in the HOCL group and 7.1 ± 1.8 in the control group (p > 0.05). No adverse events are reported. Topical 0.01% HOCL through ultrasonic atomization is a tolerable and effective eyelid hygiene treatment for blepharitis.

Meibomian gland secretion quality association with ocular parameters in university students during COVID- 19 restrictions

PurposeTo determine if the Meibomian Gland (MG) secretion quality is associated with symptoms of ocular discomfort, hours of Video Display Terminals (VDT) use, eyelid margin abnormalities, conjunctival hyperemia, and Meibomian Gland Loss Area (MGLA) in a sample of university students.MethodsAn online survey that included an Ocular Surface Disease Index (OSDI) questionnaire and an extra question about hours of VDT use recruited an initial sample of 183 participants. Only 120 participants that fulfilled the inclusion criteria were scheduled for a battery of ocular surface and MG specific exam. The tests include: 1) meibometry, 2) slit lamp exploration of eyelid margin abnormalities (irregularity, hyperemia and MG orifices plugging), MG secretion quality and conjunctival hyperemia, and 3) Meibography.ResultsSignificant positive correlations between the MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA, nasal conjunctival hyperemia, and temporal conjunctival hyperemia (Spearman Rho; all r>0.186, p<0.042) were found. Multivariate regression found association between OSDI with hours of VDT use (B=0.316, p=0.007), and eyelid hyperemia (B=0.434, p≤ 0.001). A statistical association between MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA and conjunctival hyperemia (Fisher’s exact; all p<0.039) were found. Multivariate regression found association between MG secretion quality with MG orifices plugging (B=0.295, p=0.004) and meibometry (B=-0.001, p=0.029).ConclusionParticipants with higher values in MG secretion quality have higher values in eyelid margin hyperemia, MG plugging, MGLA, and conjunctival hyperemia. No direct relationship between MG secretion quality and hours of VDT use or OSDI were found.

Evaluation of changes in ocular surface disease index score and meibomian gland parameters in primary pterygium.

Pterygium is a commonly occurring ocular pathology, characterized by a benign proliferation of conjunctiva which extends onto the corneal surface. Abnormal tear film and meibomian gland (MG) dysfunction have been linked to pterygium development. This study was done to evaluate the changes taking place in the Ocular Surface Disease Index (OSDI) score and other tear film parameters with MG parameters in patients of primary pterygium as well as evaluation of the relation between them in pterygium. This was a case-control study, done in a tertiary care hospital in North India. Patients presenting to the ophthalmology outpatient department with a diagnosis of pterygium were enrolled in the pterygium study group along with their gender- and age-matched controls. Both groups were evaluated for OSDI score and other tear films and MG parameters were compared. The results were analyzed using SPSS version 24.0. A P < 0.05 was considered statistically significant. The OSDI score was significant among the study groups with a P = 0.006 and the MG parameters of MG expression score, lid margin abnormality, and meiboscore were also significant with a P = 0.002, 0.002, and < 0.01, respectively. There is a positive association between pterygium, tear film abnormality, and MG disease (MGD). A strong association was also established between MGD and dry eye. Any alteration in one will aggravate the other.

A study to assess meibomian gland morphology using meibography in posterior blepharitis patients and normal population: A hospital-based observational study

ABSTRACT Introduction: Noncontact infrared meibography (NIM) is a technique for quantitative assessment of meibomian gland (MG) dysfunction by providing images of the morphology of MGs. Aim: The aim of this study is to assess MG morphology using NIM (with meiboscore values) in posterior blepharitis patients and the normal population and to assess the lid margin abnormality score (LMAS), lid margin expression score, tear breakup time (TBUT), and Schirmer test values in posterior blepharitis. Methods: This was a hospital-based study on 100 consecutive patients attending the outpatient department of ophthalmology of the study institute, from June 2019 to May 2020 after getting ethical clearance. The study included 75 patients with symptoms and signs of posterior blepharitis and 25 normal patients with no evidence of posterior blepharitis. All patients were examined using slit lamp biomicroscopy for signs of posterior blepharitis and TBUT, superficial punctate keratopathy, Schirmer 1 test, and LMAS. NIM was performed for both upper and lower eyelids and was documented using the meiboscore system. Results: The meibography gland dropout was significantly higher in posterior blepharitis patients (P &lt; 0.01) compared to normal patients. The normal patients had normal meibography in 32% and total meiboscore of Grade 1 in 56%. The LMAS was significantly higher in posterior blepharitis patients. Superficial punctate keratitis was not significantly higher in posterior blepharitis patients. The lid margin expression score was significantly higher in posterior blepharitis (P &lt; 0.01). TBUT was significantly shorter in posterior blepharitis people (P &lt; 0.01). The Schirmer test showed an adequate tear secretion in both groups of patients. Conclusion: NIM system can be performed easily, quickly, noninvasively and was a patient-friendly method to obtain information about the MG morphology. In our study, the majority of patients with posterior blepharitis showed significant gland dropout as viewed on NIM, compared to the normal cases studied.

Clinical Features of Lid Margin, Meibomian Gland and Tear Film Changes in Patients with Primary Pterygium

Abstract Introduction: The aim of this study was to clinically evaluate lid margin abnormality, meibomian glands expression and tear function changes in patients with primary pterygium. Methods: Fifty normal and 50 primary pterygia participants without other ocular pathologies were randomly selected from patients who attended an ophthalmology visit. The lid margin abnormality, meibomian gland expression, tear break-up time, Schirmer's test results and ocular surface disease index (OSDI) were evaluated. Multiple tear meniscus values include the lower tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were also measured using time-domain ocular coherence tomography. Comparative analyses between groups were performed for all parameters. A statistical significance level of P < 0.05 was considered. Association of ocular surface disease index with lid margin abnormality scores, meibomian gland expression and tear break-up time were evaluated. Results: Ocular surface disease index, lid margin abnormality and meibomian gland expression scores were significantly higher in primary pterygium patients than in normals (P < 0.001). Tear break-up time, Schirmer's test results, lower TMH, TMD and TMA values donot differ between the two groups (P > 0.05). Correlation analysis demonstrated that lid margin abnormality, meibomian gland expression and tear break-up time were significantly correlated with ocular surface disease index (P < 0.05). Conclusions: Primary pterygium may cause alteration of lid margin and meibomian glands expressions, which is associated with ocular discomfort. Early detection of lid margin and meibomian gland changes seem to be important to understand the relationship between pterygium, tear film functions and changes of the ocular surface.

The correlation between Demodex infestation and meibomian gland dysfunction at different ages

BackgroundThis study aimed to explore the associations between Demodex infestation and the ocular surface characteristics of meibomian gland dysfunction (MGD) in different age groups, to further understand the effect of Demodex on MGD.MethodsA total of 202 consecutive MGD patients aged 18 to 70 years were randomly recruited. All patients were divided into two groups based on their age: young patients (18–40 years) and elderly patients (41–70 years). The main observations were the different relationship between Demodex infestation and ocular surface and meibomian gland (MG) parameters in two age groups. We also compared ocular surface and MG parameters between the young and the elderly groups. Demodex infestation was diagnosed based on expert consensus in China.ResultsOur results indicated significant differences among young Demodex-positive, suspicious-positive, and negative patients in MG dropout (P = 0.000), plugging of MG orifices (P = 0.000), lid margin abnormality (P = 0.000), and meibum quality (P = 0.000). In elderly patients, there were significant differences among the Demodex-positive, suspicious-positive, and negative groups in terms of ocular surface disease index (OSDI) (P = 0.037), fluorescein tear film break-up time (FBUT) (P = 0.002), corneal fluorescein staining (CFS) (P = 0.036), MG dropout (P = 0.000), plugging of MG orifices (P = 0.008), lid margin abnormality (P = 0.000), and MG expression (P = 0.037). The mean number of mites in elderly Demodex-positive patients (10.64 ± 7.50) was greater than that of in young patients (7.60 ± 4.71) (P = 0.014). MG dropout (P = 0.000), plugging of MG orifices (P = 0.006), lid margin abnormality (P = 0.000), MG expression(P = 0.001), and meibum quality (P = 0.032) were more severe in elderly Demodex-positive patients. Additionally, FBUT (P = 0.005) was lower and tear film lipid layer thickness (LLT) (P = 0.001) was higher in the elderly.ConclusionThe effect of Demodex infestation on the ocular surface and MG parameters of MGD was different in patients of different ages. It is necessary to pay more attention to the diagnosis and treatment of Demodex infestation in MGD.