Lid Margin Abnormality Research Articles

Ocular surface disease in psoriatic patients in a developing country.

To evaluate ocular surface changes among patients with psoriasis in Malaysia, a developing country in Southeast Asia. An interdisciplinary case-control study (60 psoriasis patients and 40 control subjects) to look at the differences in ocular surface manifestations between patients with psoriasis and a group of age-, gender- and ethnicity-matched healthy controls. One hundred and twenty eyes of 60 patients with psoriasis and 80 eyes of 40 healthy controls without psoriasis were included in the study. Mild-to-moderate psoriasis was found in 42 patients (70%), while 18 patients (30%) had severe psoriasis. Psoriatic arthritis was found in 19 patients (32%). Of the 60 psoriatic patients, the prevalence of ocular involvement was 65% (39/60), in which 32% (19/60) had dry eyes, 27% (16/60) had lid margin abnormalities, 33% (20/60) had cataract, and one had history of anterior uveitis. Compared to controls, ocular surface of psoriatic patients showed more eyelid margin abnormalities, higher meibomian gland loss and lower tear filmbreak-up time. The estimated odds ratio for dry eyes in the psoriasis group was 2.2 (95% CI: 0.8-6.9). Ocular surface disorders encompassing eyelid margin abnormalities, meibomian gland loss and tear dysfunction occur at an earlier and higher rate among psoriatic patients.

Therapeutic effect of intense pulsed light with optimal pulse technology on meibomian gland dysfunction with and without ocular Demodex infestation.

BackgroundTo evaluate the therapeutic effect of intense pulsed light (IPL) therapy with optimal pulse technology (OPT) on meibomian gland dysfunction (MGD) with and without ocular Demodex infestation.MethodsThis prospective study included 150 patients with MGD who were divided into Demodex-infested (DI) and non-infested (control) groups according to Demodex counts determined by epilating eyelashes to evaluate. Each patient underwent three OPT treatment sessions at 3-week intervals. Best corrected visual acuity (BCVA), intraocular pressure (IOP), Demodex counts, Ocular Surface Disease Index (OSDI) score, conjunctival congestion, tear meniscus height (TMH), tear breakup time (TBUT), Schirmer I test (SIT), corneal and conjunctival fluorescein staining scores, meibomian gland (MG) macrostructure, lid margin abnormality, MG expressibility, and meibum quality were assessed before the first treatment as baseline and at 1, 2, and 3 months (M1, M2 and M3, respectively) after treatment.ResultsThe incidence of Demodex infestation was 59.15% (84/142) at baseline and the final Demodex eradication rate at M3 was 83.3% (70/84). Corneal staining and conjunctival congestion showed slower improvement in the DI group than in the control group at M1 and M2 (P<0.05), but was significantly improved at M3 than that at with baseline (P<0.01). Both the groups showed significant improvement in OSDI, conjunctival congestion, TBUT, corneal and conjunctival staining, MG dropout, lid margin abnormality, MG expressibility, and meibum quality at M3 (P<0.05). No differences were observed for BCVA, IOP, SIT, and TMH before and after treatment in both the groups (P>0.05).ConclusionsThis new-generation IPL with OPT treatment results in greater improvement in MG expressibility and meibum quality in MGD patients with Demodex infestation than in those without, but not for corneal staining.

Relationship Between Eyelid Pressure and Lacrimal Status in Mild Facial Nerve Palsy.

Purpose: Facial nerve palsy is frequently associated with both epiphora and dry eye, and orbicularis oculi muscle weakness or paralysis is the main cause of these symptoms. Eyelid pressure is a quantitatively measurable parameter for evaluating the tone and function of the orbicularis oculi muscle. The aim of this study was to examine the relationship between eyelid pressure and lacrimal status in patients with mild facial nerve palsy.Methods: This prospective, interventional study included 10 patients with unilateral facial nerve palsy. The severity of facial nerve palsy was determined using the CADS scale (cornea, static asymmetry, dynamic function, and synkinesis). Eyelid pressure was measured using a blepharo-tensiometer. Lacrimal status was quantified through tear meniscus height (TMH), clinical assessment of meibomian gland dysfunction (MGD) (eyelid margin abnormalities, Marx line, meibum expression, and loss of meibomian glands), corneal fluorescein staining, tear break-up time, and Schirmer test I results.Results: All 10 patients suffered from mild facial nerve palsy without eyelid ectropion or entropion, or gustatory epiphora. Lower eyelid pressure during forceful eye closure was significantly decreased in affected eyes (P = 0.007), but upper eyelid pressure during forceful eye closure and static upper and lower eyelid pressure were not significantly different between the affected and unaffected sides (P > 0.050). The TMH, MGD, and dry eye measurements showed no significant difference between the affected and unaffected eyes (P > 0.050).Conclusions: Mild facial nerve palsy is associated with decreased lower eyelid pressure during forceful eye closure. However, no other differences in upper eyelid pressure during forceful eye closure, static eyelid pressure, TMH, MGD, or dry eye disease symptoms were noted. These results imply that eyelid pressure slightly decreases due to mild facial nerve palsy, but this change may be clinically negligible.

Relation of Dietary Fatty Acids and Vitamin D to the Prevalence of Meibomian Gland Dysfunction in Japanese Adults: The Hirado-Takushima Study.

Intervention studies have shown that n-3 polyunsaturated fatty acid (PUFA) supplementation is effective for the treatment of meibomian gland dysfunction (MGD). Ointment containing an analog of vitamin D has also been found to improve symptoms and signs of MGD. We have now evaluated the relation of MGD prevalence to dietary intake of fatty acids (FAs) and vitamin D among a Japanese population. Subjects comprised 300 adults aged 20 to 92 years residing on Takushima Island. MGD was diagnosed on the basis of subjective symptoms, lid margin abnormalities, and meibomian gland obstruction. Dietary FA and vitamin D intake was estimated with a brief-type self-administered diet history questionnaire. MGD prevalence was 35.3%. Multivariate adjusted odds ratios (95% confidence intervals) between extreme quintiles of intake for MGD prevalence were 0.40 (0.16–0.97) for total fat, 0.40 (0.17–0.97) for saturated FAs, 0.40 (0.17–0.97) for oleic acid, 0.52 (0.23–1.18) for n-3 PUFAs, 0.63 (0.27–1.49) for n-6 PUFAs, 1.32 (0.59–2.95) for the n-6/n-3 PUFA ratio, and 0.38 (0.17–0.87) for vitamin D. Total fat, saturated FA, oleic acid, and vitamin D intake may thus be negatively associated with MGD prevalence in the Japanese.

Associations with meibomian gland loss in soft and rigid contact lens wearers

PurposeThis study aimed to evaluate the structural changes in meibomian glands (MGs) and meibomian gland dysfunction (MGD)-associated ocular surface alterations in contact lens (CL) wearers. MethodsThis prospective, multi-center, cross-sectional study included 44 soft CL wearers, 21 rigid CL wearers, and 26 healthy non-wearers. After completing the Ocular Surface Disease Index (OSDI) questionnaire, the participants were examined for lid margin abnormalities, tear breakup times, ocular surface staining, meibum quality and expressibility. Afterwards upper and lower eyelid meibography and Schirmer I test were performed. ResultsA total of 91 participants (64 females and 27 males) (91 eyes) were classified into three groups. The mean percentage of meibomian gland loss (PMGL) was 25.3 ± 12.5 % in soft CL wearers, 34 ± 13.4 % in rigid CL wearers, and 18.4 ± 9.2 % in the control group. Mean OSDI score was higher in soft CL wearers (15.5 ± 18) than in the control group (3.5 ± 2.6) (p < 0.001) and the OSDI scores were correlated with mean PMGL in CL wearers (r = 0.411, p = 0.002, r = 0.588, p = 0.005, respectively). In soft CL wearers, the duration of CL use was the only predictive variable for mean PMGL in multivariate analysis. In a regression model including both CL groups, age and rigid CL material were predictive variables for mean PMGL. ConclusionsCL use may cause MGD and this effect may be more pronounced in rigid CL wearers. In soft CL wearers, the duration of CL use is an important variable associated with MG loss, and subjective symptoms may guide the prediction of MG loss in these cases.

Proposed Algorithm for Management of Meibomian Gland Dysfunction Based on Noninvasive Meibography.

Although the pathophysiology of meibomian gland dysfunction (MGD) remains incompletely understood, many treatment options have recently become available. According to an international workshop report, treatment selection for MGD should be based on a comprehensive stage classification dependent on ocular symptoms, lid margin abnormalities, meibum grade, and ocular surface staining. However, it is often difficult to evaluate all parameters required for such classification in routine clinical practice. We have now retrospectively evaluated therapeutic efficacy in MGD patients who received five types of treatment in the clinic setting: (1) meibocare (application of a warm compress and practice of lid hygiene), (2) meibum expression plus meibocare, (3) azithromycin eyedrops plus meibocare, (4) thermal pulsation therapy plus meibocare, or (5) intense pulsed light (IPL) therapy plus meibocare. Patients in each treatment group were classified into three subsets according to the meiboscore determined by noncontact meibography at baseline. Eyes in the IPL group showed improvement even if the meiboscore was high (5 or 6), whereas meibocare tended to be effective only if the meiboscore was low (1 or 2). The meiboscore may thus serve to guide selection of the most appropriate treatment in MGD patients. Prospective studies are warranted to confirm these outcomes.

Relationship between eyelid margin irregularity and meibomian gland dropout

PurposeTo examine the relationship between lid margin abnormalities and meibomian gland loss in infrared meibography. MethodsThis study was a retrospective chart review of 170 patients with dry eye disease. A correlation analysis between eyelid margin abnormalities and meibomian gland dropout in infrared meibography was performed using data from 141 eyes. We graded the following eyelid margin abnormalities: irregular lid margin, vascular engorgement, plugging, anterior placement of the mucocutaneous junction, exposed terminal duct, and presence of tattoos. Multiple regression analyses were performed with meiboscore (meibomian gland dropout grade) as the dependent variable and age, sex, lid margin abnormality grades, and total grading score of lid margin abnormalities as the covariates. In addition, Meibomian glands structure were examined in those with eyelid margin dimpling using meibography in 25 eyes. ResultsIn the multiple regression analysis, an irregular lid margin in the upper eyelid was associated with a higher meiboscore after controlling for age and sex (coefficients B = 1.379, p = 0.025). Other lid margin abnormalities did not significantly affect the meiboscore. In the lower eyelids, irregular lid margin (coefficients B = 0.602, p = 0.009) and total grading score of lid margin abnormality were associated with higher meiboscores (coefficients B = 0.100, p = 0.022). Of the 25 eyes with dimples, 21 (84%) showed focal or complete meibomian gland loss at the site. ConclusionsLid margin abnormalities were found to be associated with meibomian gland dropout.

Recurrent upper eyelid trachomatous entropion repair: long-term efficacy of a five-step approach.

To describe the lid characteristics of recurrent upper eyelid trachomatous entropion and to report the long-term outcomes of a five-step surgical approach based on the principles of upper eyelid crease lamellar splitting and retractor release with redirection. Retrospective case review of adult patients with recurrent upper eyelid trachomatous entropion who had undergone surgical correction using the five-step surgical technique between March 2014 and March 2018. Cases with primary entropion and/or <2 years of follow-up were excluded from this series. Eyelid deformities (type of trichiasis, anterior lamellar laxity, lid margin abnormality, lid retraction and lagophthalmos), recurrence of entropion and trichiasis, cosmetic satisfaction, and surgical complications. Forty-two upper eyelids in 33 patients met inclusion criteria. Preoperative anterior lamellar laxity was present in 36 eyelids (85.7%), lid retraction in 31 eyelids (73.8%) with a mean preoperative MRD1 of 6.48 ± 1.1 mm, atrophic tarsus in 28 eyelids (66.7%), lid margin notching in 22 eyelids (52.4%), and lagophthalmos in 15 eyelids (35.7%). The surgical success rate was 92.9% (95% CI 0.805-0.985). There was no documented recurrence of entropion over a mean follow-up period of 31.79 months. Postoperative trichiasis without entropion occurred in three eyelids, which required repeat epilation. The five step-approach based on the principles of lamellar splitting is effective in correction of recurrent trachomatous entropion with long-term stability. The procedure addresses the fundamental changes frequently seen in recurrent cases, in particular anterior lamellar laxity, scarred shortened posterior lamella, and trichiasis.

Multicenter Study of Intense Pulsed Light for Patients with Refractory Aqueous-Deficient Dry Eye Accompanied by Mild Meibomian Gland Dysfunction.

Aqueous-deficient dry eye (ADDE) and meibomian gland dysfunction (MGD) can be refractory to therapy. Intense pulsed light (IPL) was recently introduced as an effective treatment for MGD. We here evaluated the efficacy of IPL combined with MG expression (MGX) compared with MGX alone (n = 23 and 20, respectively) for patients with refractory ADDE with mild MGD at three sites. Symptom score, visual acuity (VA), noninvasive breakup time (NIBUT) and lipid layer thickness (LLT) of the tear film, lid margin abnormalities, fluorescein BUT (FBUT), fluorescein staining, tear meniscus height (TMH), meibum grade, meiboscore, and Schirmer’s test value were assessed at baseline and 1 and 3 months after treatment. LLT, plugging, vascularity, FBUT and NIBUT were improved only in the IPL-MGX group at three months compared with baseline. All parameters with the exception of VA, meiboscore, TMH, Schirmer’s test value were also improved in the IPL-MGX group compared with the control group at three months, as was VA in patients with central corneal epitheliopathy. Although IPL-MGX does not affect aqueous layer, the induced improvement in quality and quantity of the lipid layer may increase tear film stability and ameliorate symptoms not only for evaporative dry eye but for ADDE.

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

BackgroundTo evaluate the correlations between lipid layer thickness (LLT) and morphology and function of the meibomian glands in patients who were diagnosed as meibomian gland dysfunction (MGD) in different age groups.MethodsPatients who have diagnosed as obstructive MGD were included in this prospective, cross-sectional study. Patients were divided into three groups: young (ages 20–39 years), middle-aged (ages 40–59 years), and older (aged ≥60 years). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and were evaluated for LLT, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT) measurement, invasive TBUT (ITBUT), corneal fluoresceinstaining (CFS) score, eyelid margin abnormalities, Schirmer I test, and MG function and morphology, by using the Keratograph 5 and LipiView interferometer.ResultsTwo hundred and nine patients (209 eyes) were included. The median LLT of all patient was 57 nm (IQR, 36.5 nm), and the LLT values were significantly different among the young group (median, 51 nm; IQR, 23.5 nm), middle-aged group (median, 59.5 nm; IQR 46.5 nm) and older group (median, 62 nm; IQR, 42.5 nm) (P = 0.033, Kruskal-Wallis test). In regression analyses controlling for confounder factors sex and MG loss, the LLT was positively correlated with age (β = 5.539, P = 0.001). There was a negative correlation between LLT and MG dropout in the all (r = − 0.527, P < 0.001), young (r = − 0.536, P < 0.001), middle-aged (r = − 0.576, P < 0.001), and older (r = − 0.501, P < 0.001) groups. LLT was positively correlated with the MG expressibility in the all (r = 0.202, P = 0.003), middle-aged (r = 0.280, P = 0.044) and older (r = 0.452, p < 0.001) groups, but it was no statistical significance in the young group (r = 0.007, P = 0.949).ConclusionsThe thickness of LLT was increased with age and significantly correlated with both MG secretion and morphology in middle-aged and older patients with obstructive MGD. LLT measurement is a useful screening tool for detecting obstructive MGD and age as an influential factor should be accounted for when interpreting the meaning of the LLT value.Trial registrationNCT02481167; Registered 25 June, 2015.

Mucous membrane grafting (fibrin glue vs. suture) for lid margin pathologies in Stevens-Johnson syndrome: randomized comparative study.

To compare fibrin glue (with three cardinal sutures) (FG) and polygalactin suture (PS) for mucous membrane grafting (MMG) in terms of graft apposition and recurrence of lid margin keratinization (LMK) and metaplastic lashes (ML) in patients with Stevens-Johnson syndrome (SJS). Prospective randomized comparative interventional study. Twenty patients diagnosed with SJS and lid margin abnormalities including LMK with or without ML were randomized to undergo either fibrin glue (FG)-assisted MMG (n = 10) or continuous 8-0 polygalactin suture (PS)-assisted MMG (n = 10). They were evaluated preoperatively and during follow-up at 1 week and 1, 2, 3, and 6 months. The parameters assessed were best-corrected visual acuity (BCVA), tear break-up time (TBUT), Schirmer-1 test, corneal and conjunctival complications, graft apposition and width (GW), LMK, ML, impression cytology, and operative time. The primary outcome measures are incidence of graft displacement and recurrence of LMK and ML. None of the eyelids in FG group (0/40) and 1 eyelid in PS group (1/40) had graft displacement. Recurrence of LMK occurred in 7.5% of eyelids (3/40) in both the study groups. Recurrence of ML occurred in 2.5% (1/40) in FG group and 5% (2/40) in PS group. The mean operative time for MMG in FG group was 39.5 ± 2.40 min and in PS group was 56 ± 1.63 min (p = 0.001). As graft apposition with suture involves significantly longer intraoperative time, if cost is not a limiting factor then fibrin glue is a viable option for the MMG for lid margin pathologies.

Investigation of Meibomian Gland Function and Dry Eye Disease in Patients with Graves' Ophthalmopathy.

We prospectively evaluated the relationship between meibomian gland dysfunction (MGD) and Graves’ ophthalmopathy (GO) in 19 patients (38 eyes) with subjective dry eye symptoms, compared to 14 age-matched normal participants (14 eyes). Extraocular muscle and lacrimal gland enlargement were evaluated by magnetic resonance imaging (MRI). Ocular surface examinations included fluorescein staining for keratoconjunctival epithelial damage, tear breakup time (TBUT) evaluation, and Schirmer’s test. Dry eye symptoms were evaluated with the Dry Eye-related Quality-of-Life Score (DEQS) questionnaire. Lid-margin abnormalities, meibum grade, and meiboscores were assessed using meibography. Clinical activity scores and T2 signal intensity ratios were used to define GO activity. All GO patients had obstructive MGD and 79% exhibited levator muscle enlargement. Ocular surface parameters of TBUT (p = 0.000), meibum score (p = 0.000), eyelid vasculitis (p = 0.000), meiboscore of the upper lid (p = 0.002), total meiboscores (p = 0.001), and DEQS (p = 0.000) significantly differed between GO patients and normal subjects. In addition, GO patients had significantly more abnormalities of the central region of the upper eyelid than normal subjects (p = 0.000). Thus, MGD might be related to eye discomfort and deterioration of the ocular surface in GO patients. Inflammation and morphological meibomian gland changes might be characteristic of GO.

A Novel Quantitative Index of Meibomian Gland Dysfunction, the Meibomian Gland Tortuosity.

PurposeTo quantitatively measure meibomian gland (MG) tortuosity in meibomian gland dysfunction (MGD) patients and normal controls and to observe the efficacy of evaluating MG tortuosity for the diagnosis of MGD.MethodsThis cross-sectional study enrolled 32 obstructive MGD patients and 28 normal volunteers. Clinical assessments were performed, including symptom questionnaires, tear meniscus height, tear break-up time (TBUT), corneal fluorescein staining, lid margin abnormality, MG expressibility, and meibography. The meibomian gland tortuosity and meibomian gland density were measured by VIA software.ResultsThe mean age of the patients in the MGD group was 33.28 ± 9.28 years, and that of the normal controls was 25.25 ± 11.19 years. The average tortuosity of all MGs in the MGD patients was significantly larger than in the normal controls (P < 0.05). We further stratified the MGD patients into symptomatic MGD and asymptomatic groups. The average tortuosity of all MGs and of the central eight MGs was significantly higher in the symptomatic MGD patients than in the asymptomatic MGD patients (P < 0.05). Significant linear correlations were found between MG tortuosity and the lid margin score, meiboscore, meibum expressibility score, and TBUT (P < 0.05). When the diagnosis of obstructive MGD was based on the tortuosity of the central eight MGs of both eyelids, the sensitivity and specificity were 100% and 100%, respectively.ConclusionsMG tortuosity is an effective index to delineate MG morphology and to diagnose MGD, especially for the diagnosis of early-stage MGD.Translation RelevanceCalculating tortuosity quantitatively may play an important role in the diagnosis of MGD.

Morphological Changes of Meibomian Glands in Men With Benign Prostate Hyperplasia.

Meibomian glands are subject to regulation by sex hormones. We have now investigated the possible relation between benign prostate hyperplasia (BPH) and meibomian gland dysfunction (MGD). Men diagnosed with BPH and receiving treatment with tamsulosin and age-matched male control subjects who attended Itoh Clinic, Saitama, Japan, were enrolled. An ocular symptom score, lid margin abnormality score, and superficial punctate keratopathy score as well as the meiboscore (0-6), meibum grade, breakup time of the tear film, and Schirmer test values were evaluated. Male pattern baldness was also graded according to the Hamilton-Norwood scale. Forty-four eyes of 44 men with BPH (mean age ± SD, 76.1 ± 2.2 years) and 46 eyes of 46 control subjects (mean age ± SD, 75.3 ± 6.2 years) were enrolled. The meiboscore in the BPH group (4.5 ± 1.4) was significantly higher than that in the control group (1.8 ± 1.5, P < 0.0001). Breakup time of the tear film was significantly shorter (3.6 ± 1.7 vs. 5.6 ± 2.5 seconds, P < 0.0001), and Schirmer test value was significantly smaller (9.8 ± 4.8 vs. 13.3 ± 8.0 mm, P = 0.048) in the BPH group than that in the control group. Other ocular parameters did not differ significantly between the 2 groups. The proportion of men with androgenic alopecia was also higher in the BPH group than that in the control group. BPH was associated with meibomian gland loss and instability of the tear film as well as with the presence of androgenic alopecia.

Effect of 3-Hydroxy-3-Methyl-Glutaryl-Coenzyme A Reductase Inhibitors on the Meibomian Gland Morphology in Patients with Dyslipidemia

Previous studies have suggested an association between dyslipidemia and meibomian gland dysfunction (MGD). The aim of this prospective, nonrandomized clinical study is to evaluate the possible association of dyslipidemia and its treatment with meibomian gland (MG) morphologic changes by standardized meibography. Prospective, nonrandomized clinical study. Two groups of participants were enrolled: group 1, comprised of patients under regular 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin) treatment for dyslipidemia, and group 2, those with newly diagnosed dyslipidemia who were under lifestyle interventions. Meibography was performed at baseline and at both the 6- and 12-month visits and were graded by meiboscores. Participants underwent slit lamp examination for signs of changes in meibum quality and MG lid morphologic features. The Ocular Surface Disease Index questionnaire was given to measure subjective symptoms of ocular surface disease. Dry eye parameters including tear meniscus height, noninvasive first and average tear film break-up time, and Schirmer test results were also recorded. Ninety-eight participants completed this longitudinal study over 12months. There were statistically significant changes in total meiboscores (P= .01) and upper eyelid meiboscores (P= .012), lid margin abnormality scores (P= .0059), and meibum quality (P= .0002) in the statin group during follow-up visits. Similar changes of upper eyelid meiboscores (P= .046) and meibum quality (P= .046) were noted in the nonstatin group. Meibomian gland atrophy and deterioration of meibum quality continued in the long term among participants with dyslipidemia even under statin usage.

Eyelid Disorders in Ophthalmology Practice: Results from a Large International Epidemiological Study in Eleven Countries.

PurposeAnecdotal evidence suggests that eyelid disorders are common, although estimates of prevalence vary. The current study determines the prevalence of eyelid disorders, meibomian gland dysfunction (MGD) and related diseases (specifically ocular surface disease) in a population of patients presenting for routine ophthalmologic consultations.MethodsThis cross-sectional epidemiologic survey evaluated patients presenting for routine ophthalmic visits. During the consultation an ophthalmologist completed a questionnaire, and each patient underwent an ophthalmic examination and completed a quality of life questionnaire.ResultsThree hundred forty-nine ophthalmologists, recruited from 11 countries, provided data on 6525 patients. Patients were predominantly females (61.6%). The mean age of the study population was 57.0 ± 17.6 years. Eyelid disorders were diagnosed in 5109 (78.3%) patients and were statistically associated with: atopic dermatitis, seborrheic dermatitis, dry eye, age-related macular degeneration, diabetes, cataract, allergy and MGD (P < 0.05, all associations). Eyelid abnormalities were identified in 59.6% of patients; conjunctival or corneal abnormalities were observed in 64.9% and 28.1% of patients, respectively. MGD was diagnosed in 54.3% patients and was statistically significantly associated with the presence of eyelid disorders and eyelid margin abnormalities (P < 0.001, both comparisons). Dry eye was diagnosed in 61.8% of patients. Concurrent dry eye and MGD were present in 67.6% of patients. Most patients reported some degree of impaired vision and daily/work activities related to dry eye. Impact on contact lens usage, emotions and quality of sleep was also reported. The effects on daily life were associated with the presence of MGD.ConclusionIn conclusion, eyelid disorders were highly prevalent in this ‘real-world’ population of patients from ophthalmology clinics. Routine ophthalmologic consultations provide an opportunity to improve patient quality of life and to modify topical therapy in patients who may be predisposed to eyelid disorders.

Prevalence of Meibomian Gland Dysfunction and Its Effect on Quality of Life and Ocular Discomfort in Patients with Prosthetic Eyes

Purpose: To evaluate the influence of ocular discomfort and meibomian gland dysfunction (MGD) on quality of life in patients with an ocular prosthesis. Methods: a prospective analysis was conducted on 18 patients with a unilateral ocular prosthesis. Evaluation of ocular discomfort symptoms, lid margin abnormalities (LMA), meibomian gland expression, meibography and a psychometric evaluation using the National Eye Institute Visual Function Questionnaire (NEI VFQ), Facial Appearance subscale of the Negative Physical Self Scale (NPSS-F), Hospital Anxiety and Depression Scale (HADS) and the DAS24 to evaluate anxiety and depression. Results: the statistically significant differences observed between normal and prosthetic eyes related to ocular symptoms and the meibography score (p = 0.0003). A negative correlation was reported between NEI VFQ score and meibography score (r = −0.509; p-value = 0.022). A positive correlation was detected with NPSS (r = 0.75; p-value &lt; 0.0001), anxiety HADS score (r = 0.912; p-value = 0.001) and depression HADS score (r = 0.870; p-value &gt; 0.0001). Conclusion: MGD represents the most common cause of evaporative dry eye disease, due to the reduction of the thickness of the lipid layer of the tear film. The occurrence of MGD in patients with prosthetic eyes is very common. Anxiety and depression were correlated to ocular discomfort and MGD, and this could affect the quality of life in patients with an ocular prosthesis.

The effect of oral isotretinoin therapy on meibomian gland morphology and dry eye tests

Purpose The aim of study was to evaluate the effects of oral isotretinoin on meibomian gland (MG) morphology detected with non-contact meibography and to investigate its relation with clinical dry eye tests. Methods Forty-five acne patients treated with isotretinoin underwent a full ophthalmological examination at baseline and in the fourth month as follows: ocular surface disease index (OSDI) questionnaire, assessments of tear film break-up time (TFBUT), corneal fluorescein staining, Schirmer test, meibum expression, and lid margin abnormalities. Non-contact meibography imaging and noninvasive tear break up time (NI-BUT) assessments were also performed. The changes in MGs were scored (meibography score) as grade 0, no change; grade 1, mild; grade 2, moderate; and grade 3, marked. Results There was a statistically significant change in OSDI, corneal fluorescein staining, lid margin abnormality, and meibum expression score during the treatment compared to baseline values (p < .001, p = .02, p < .001, and p < .001, respectively). All meibography scores showed a positive correlation with the lid margin abnormality and meibum expression score but did not correlate with the TFBUT, NI-BUT, Schirmer test, or the corneal fluorescein staining score. Conclusion The morphologic analysis using non-contact meibography is a useful method for assessing isotretinoin-related changes in MGs.

The Efficacy of Intense Pulsed Light Combined With Meibomian Gland Expression for the Treatment of Dry Eye Disease Due to Meibomian Gland Dysfunction: A Multicenter, Randomized Controlled Trial.

Objectives:To compare the efficacy of intense pulsed light (IPL) combined with Meibomian gland expression (MGX), and instant warm compresses combined with MGX, for treatment of dry eye disease (DED) due to meibomian gland dysfunction (MGD).Methods:In a prospective, multicenter, interventional study, 120 subjects with DED due to MGD were randomized 1:1 to an IPL arm or a control arm. Each subject was treated 3 times at 3-week intervals. The primary outcome measure was the tear break up time (TBUT). Tear break up time and a few additional outcome measures were evaluated at the baseline and at 3 weeks after the last treatment.Results:All outcome measures improved in both arms, but in general, the improvement was significantly larger in the IPL arm. Tear break up time increased by 2.3±1.9 and 0.5±1.4 sec, in the IPL and control arms respectively (P<0.001). SPEED was reduced by 38% and 22% in the IPL and control arms, respectively (P<0.01). Meibomian Gland Yielding Secretion Score was improved by 197% in the IPL arm and 96% in the control arm. Corneal fluorescein staining also decreased by 51% and 24% in the IPL and control arms respectively, but the differences between the two arms were not statistically significant (P=0.61). A composite score of lid margin abnormalities improved in both arms, but more in the IPL arm (P<0.05).Conclusions:Intense pulsed light combined with MGX therapy was significantly more effective than instant warm compresses followed with MGX. This suggests that the IPL component has a genuine contribution to the improvement of signs and symptoms of DED.

Analysis of Clinical and Regional Distribution Characteristics of Obstructive Meibomian Gland Dysfunction in China: A Multicenter Study

ABSTRACT Purpose: To analyze the clinical and regional distribution characteristics of obstructive meibomian gland dysfunction (OMGD) in China. Methods: A total of 2900 patients (2900 eyes) diagnosed with OMGD were enrolled in this multicenter, cross-sectional, observational study. The Ocular Surface Disease Index (OSDI), tear film breakup time (FBUT), Schirmer test (SI), lipid layer thickness (LLT), OMGD grade, meibomian gland loss score (Meiboscore), meibum expressibility score (MES), meibum quality score (MQS), Lid margin abnormality score(LMS) and other tear film stability markers were evaluated. Results: The prevalence of dry eye in OMGD patients was 89%. There were gender differences among OMGD patients in the 30–39 and 50–59 years age groups (p < .05), and FBUT, Meiboscore, MES and MQS were significantly different among different OMGD grades (p < .05). There were significant differences in the detection indexes of OMGD patients in the six regions (p < .05), except LLT (p = .329). According to the Qinling-Huaihe River in China, OMGD patients were divided into the North Group (Shenyang and Beijing) and South Group (Wuhan, Changsha, Chongqing, and Chengdu). There was a significant difference in the detection indexes, except LLT (p = .600), between the two groups (p < .05). FBUT was significantly correlated with the OSDI (r = −0.131; p < .000). Meiboscore and LLT were significantly correlated with the OMGD grade (r = 0.299 and r = 0.106; p < .001). Age, LMS and MQS were significantly correlated with Meiboscore (r = 0.415, r = 0.256 and r = 0.328; p < .001). Conclusions: The prevalence of dry eye was high among OMGD patients. OMGD patients in different age groups may show different gender distributions. The symptoms of patients showed variation among subgroups with different OMGD grades and among different regions.