Meibomian Gland Dysfunction Severity Research Articles

Ocular neuropathic pain in a real-world patient cohort with dry eye disease: A save sight dry eye registry study

PurposeTo compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain. MethodsA cross-sectional cohort study was performed using the Save Sight Dry Eye Registry (SSDER). Patients were divided into two groups based on a clinician diagnosis of ocular neuropathic pain and Tear Film and Ocular Surface Society Dry Eye Workshop II definitions. Patient demographics, Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) scores, and DED signs were compared along with Patient Health Questionnaire-4 (PHQ-4) scores, average screen time and treatment compliance. Statistical analyses included descriptive statistics, Mann-Whitney U test, Chi-squared test of independence, and Fisher's exact test. P-values were Bonferroni corrected (p*). ResultsData from 298 patients with DED symptoms and signs (26 with ocular neuropathic pain) were analysed. There was no statistical difference in patient demographics (p*>0.0063). Patients with ocular neuropathic pain had worse final, domain, and pain-related question scores for the OSDI (p*<0.0031) and OCI (p*<0.0039) and had higher scores for anxiety and depression for the PHQ-4 (p*<0.0083). Patients with ocular neuropathic pain had a lower rate and severity of meibomian gland dysfunction (p*<0.0063). ConclusionReal-world data from the SSDER demonstrated patient demographics and clinical signs poorly differentiated patients with ocular neuropathic pain within a DED cohort. Patients with ocular neuropathic pain reported significantly worse OSDI and OCI scores, indicating greater symptom severity. While this highlighted symptom differences, further research is required to determine whether OSDI and OCI scores can assist in identifying ocular neuropathic pain in DED.

Changes in Human Meibum Lipid Composition Related to the Presence and Severity of Meibomian Gland Dysfunction.

Purpose: Changes in meibum composition and quantity in meibomian gland dysfunction (MGD) result in tear film instability and dry eye. This exploratory study aimed to identify changes in (O-acyl)-ω-hydroxy fatty acid (OAHFA) and hydrocarbon chain (HC) unsaturation levels in meibum related to the presence and severity of MGD. Methods: Meibum samples were collected from 3 cohorts of adults with no MGD, mild-to-moderate MGD, and severe MGD in a noninterventional clinical trial (NCT01979887). OAHFAs, cholesterol esters (CE), HC unsaturation, and HC length in the meibum samples were quantified with 1H-nuclear magnetic resonance spectroscopy using 2 methods of normalization. Results: Meibum samples from 62 subjects were analyzed: 21 non-MGD, 21 mild-to-moderate MGD, and 20 severe MGD. Meibum OAHFA and CE levels and HC unsaturation were reduced with increasing severity of MGD, with most pairwise comparisons significant (P < 0.05, t-tests), following the order non-MGD > mild-to-moderate MGD > severe MGD. Regardless of the resonances used for normalization, each pairwise comparison of OAHFA, CE, and HC unsaturation levels in MGD (combined severities) versus non-MGD samples was significant (P < 0.01, t-test). Analysis using various normalization equations showed reductions of 20%-22% for OAHFAs, 51%-57% for CE, and 36%-66% for HC unsaturation in MGD (combined severities) compared with non-MGD. HC length was not altered in MGD (combined severities) compared with non-MGD samples (t-test). Conclusions: Meibum OAHFA, CE, and HC unsaturation levels were reduced in MGD and were lowest in the severe MGD cohort. These findings may contribute to the understanding of the pathophysiology of MGD.

Effectiveness and safety of demodecosis blepharitis therapy under dry eye conditions

Purpose: to evaluate the effectiveness and safety of complex therapy in patients with demodex blepharitis and dry eye. Methods. 25 patients with mixed demodex blepharitis and dry eye (50 eyes; 10 men, 15 women; 61.9 ± 5.6 years) were examined before and after treatment with 0.5 % levofloxacin instillation (5 times a day, 5 days); sulfur and metronidazole gel applications (Blefarogel-forte) as part of therapeutic eyelid hygiene (Blepharogel-cleansing, Blepharolotion; starting from day 6, 2 times a day, 45 days); 0.24 % sodium hyaluronate instillation (3 times a day). Therapy effectiveness criteria were as follows: D. folliculorum mite population reduction; positive dynamics of blepharitis objective signs and meibomian gland dysfunction severity (MGD-S, points). Therapy safety criteria included the absence of negative dynamics of OSDI, tear film breakup time (TBUT, s), inferior tear meniscus height (ITMH, µm) and xerosis index (XI, points). Results. As a result of the therapy, statistically significant changes were noted, including mite population reduction (from 9.23 ± 0.81 to 3.54 ± 0.80 imagos); eyelid margins edema intensity decrease (from 3.18 ± 0.39 to 1.30 ± 0.45 points) and hyperemia decrease (from 2.90 ± 0.29 to 0.9 ± 0.3 points); MGD-S decrease (from 2.1 ± 0.3 to 0.95 ± 0.21 points); OSDI decrease (from 43.23 ± 4.70 to 25.10 ± 2.65 points); TBUT increase (from 4.05 ± 0.50 to 5.55 ± 0.50 s); XI decrease (from 5.36 ± 0.49 to 4.04 ± 0.60 points). Conclusion. The treatment of demodex blepharitis and dry eye treatment, including sulfur and metronidazole gel applications, therapeutic eyelid hygiene and 0.5 % levofloxacin and 0.24 % sodium hyaluronate instillation demonstrated a high efficiency and a good safety profile.

Dyslipidemia, body mass index, and blood glucose levels in patients with meibomian gland dysfunction

Background Systemic dyslipidemia, obesity, and elevated blood sugars may theoretically affect the meibomian lipid composition and therefore, can cause meibomian gland dysfunction (MGD). Objective This study aimed to evaluate the association of serum lipid levels, body mass index (BMI), and serum blood glucose (BG) levels in patients with MGD compared with healthy controls. Patients and methods This is a comparative observational case-control study that enrolled 40 MGD patients (cases) and 40 controls. One eye of each participant was included in the study. After a detailed history, ocular examination was done by slit lamp biomicroscopy to grade/stage the MGD. The BMI, serum fasting total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and BG levels were measured. Results The mean age of the cases was 46.75±10.93 years compared with 45.55±10.62 years in controls (P=0.620). Patients with MGD showed significantly higher serum fasting cholesterol (188.62±62.24 mg/dl),;Deg;BM;Deg;I (24.45±1.75 kg/m2), and fasting BG (110.35±32.30 mg/dl) compared with the controls (159.60±20.19 mg/dl, 23.45±1.35 kg/m2, and 98.43±27.69 mg/dl, respectively, P=0.022, 0.005, and 0.030, respectively). With increasing severity of MGD, the fasting serum cholesterol increased significantly from 136.73±24.88 mg/dl in grade 1 to 285.20±85.99 mg/dl in grade 4 (P&lt;0.001) and the fasting serum LDL levels increased from 72.64±20.33 mg/dl in grade 1 to 202.60±95.66 mg/dl in grade 4 (P&lt;0.001). In addition, the fasting serum triglycerides increased significantly as the severity of MGD increased from grade I (96.00±22.56 mg/dl) to grade III (227.09±83.44 mg/dl), (P&lt;0.001). However, The fasting HDL and BG values did not increase significantly with increasing severity of the MGD (P=0.135 and 0.181, respectively). Conclusion There is importance for screening for dyslipidemia, BMI, and BG levels in MGD cases.

Cellular senescence promotes meibomian gland dysfunction in a chronic graft-versus-host disease mouse model

PurposeAging is a well-established risk factor for meibomian gland dysfunction (MGD). We previously reported an accelerated cellular senescence phenomenon in the lacrimal glands of a murine model of chronic graft-versus-host disease (cGVHD). Herein, we aimed to elucidate the relationship between cellular senescence and MGD in cGVHD mice, utilizing the senolytic agent ABT-263. MethodsA cGVHD mouse model was established through allogeneic bone marrow transplantation (BMT) from B10.D2 to BALB/c mice. Subsequently, cGVHD mice were treated with either ABT-263 or vehicle. The eyelids of recipients were analyzed at 4-week intervals post-BMT in both groups. ResultsMeibomian gland (MG) area was significantly smaller in cGVHD mice than in syngeneic control mice. ABT-263-treated mice retained a significantly larger MG area than their vehicle-treated counterparts. Pathological and immunohistochemical examinations revealed significant reductions in eyelid tissue inflammation and pathological fibrosis in the ABT-263 group compared to that in the vehicle-treated group. Additionally, expression of DNA damage markers, senescent cell markers, and senescence-associated secretory phenotype (SASP) factors was elevated in the eyelids of cGVHD mice compared with that in syngeneic mice. The expression of these cellular senescence-associated molecules was considerably suppressed in ABT-263-treated eyelids compared to that in vehicle-treated ones. ConclusionsCellular senescence, along with expression of SASP factors, exhibited increased activity in the eyelids, particularly in the MGs of cGVHD mice. ABT-263 mitigated the severity of MGD. These findings highlight the potential of targeting cellular senescence as an effective approach for MGD treatment in cGVHD.

Evaluation of Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum.

To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.

Association of Meibomian Gland Dysfunction with Serum Lipid Profile: A Hospital-based Cross-sectional study.

Meibomian gland dysfunction (MGD) frequently leads to ocular surface disease, yet its impact on patients' overall health is often overlooked. With increase in sedentary lifestyle, decreased physical activities and exposure to the digital world people have been facing increasing incidence of dyslipidemia. To investigate the association between serum lipid profile with severity of meibomian gland dysfunction. This was an observational, analytical, cross-sectional study carried out in the department of Ophthalmology of Shree Birendra hospital from January 2019 to January 2020. Oxford grading scale was used to grade the severity of MGD as none (grade 0), mild (grade I and II), moderate (grade III), and severe (grade IV and V). Serum lipid profile was obtained from all patients with MGD and analysis was carried out. Among 100 patients in this study majority of the participants were from the age group 61-70 (n, 40%) among whom 54 (54%) were females and 46 (46%) were males. Statistically significant association was noted between increase in total cholesterol, LDL, and TG levels with severity of MGD. However no significant association was found between HDL and the stage of MGD. This study demonstrated that patients with increasing severity of meibomian gland dysfunction had greater abnormalities in their serum lipid profiles with respect to total cholesterol, LDL and triglycerides.

Using machine learning model explanations to identify proteins related to severity of meibomian gland dysfunction

Meibomian gland dysfunction is the most common cause of dry eye disease and leads to significantly reduced quality of life and social burdens. Because meibomian gland dysfunction results in impaired function of the tear film lipid layer, studying the expression of tear proteins might increase the understanding of the etiology of the condition. Machine learning is able to detect patterns in complex data. This study applied machine learning to classify levels of meibomian gland dysfunction from tear proteins. The aim was to investigate proteomic changes between groups with different severity levels of meibomian gland dysfunction, as opposed to only separating patients with and without this condition. An established feature importance method was used to identify the most important proteins for the resulting models. Moreover, a new method that can take the uncertainty of the models into account when creating explanations was proposed. By examining the identified proteins, potential biomarkers for meibomian gland dysfunction were discovered. The overall findings are largely confirmatory, indicating that the presented machine learning approaches are promising for detecting clinically relevant proteins. While this study provides valuable insights into proteomic changes associated with varying severity levels of meibomian gland dysfunction, it should be noted that it was conducted without a healthy control group. Future research could benefit from including such a comparison to further validate and extend the findings presented here.

Association Between Tear Osmolarity and Dry Eye Signs in Patients with Obstructive Meibomian Gland Dysfunction

Purpose: To explore the correlations between tear osmolarity, as measured using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc., Dollard-des-Ormeaux, QC, Canada), and various dry eye indicators, including the Schirmer test, tear break-up time (TBUT), Oxford scale, and Ocular Surface Disease Index (OSDI), in patients with obstructive meibomian gland dysfunction (MGD).Methods: The medical records of 44 cases of obstructive MGD were reviewed. Tear osmolarity was obtained using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.). The TBUT, Schirmer test, Oxford scale, OSDI, and MGD grade were used to assess the cases, and their correlations with tear osmolarity were analyzed.Results: Spearman and Pearson correlation analyses showed a significant correlation between tear osmolarity and MGD grade (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.005). However, the results of the TBUT, Schirmer test, and Oxford scale were not significantly related to tear osmolarity. The patients were divided according to MGD severity into those with MGD grades ≤ 2 and those with MGD grades ≥ 3. Tear osmolarity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.014) showed significant differences between the two groups.Conclusions: In patients with obstructive MGD, tear osmolarity, assessed using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.), is significantly correlated with MGD grade and OSDI.

Modeling meibum secretion: Alternatives for obstructive Meibomian Gland Dysfunction (MGD)

PurposeWhile changes in meibum quality are correlated with severity of meibomian gland dysfunction (MGD) and dry eye disease, little is known regarding the mechanics of meibum secretion. The purpose of this study was to develop a finite element model of meibum secretion and evaluate the effect of various factors that might impact meibum delivery to the ocular surface. MethodsA finite element analysis in COMSOL 6.0 was used to simulate the flow of meibum within the gland's terminal excretory duct. Historical normal human meibum rheology data taken over the meibum melting range from fluid (35–40 °C) to solid (25–30 °C) were then used to calculate the minimum yield stress and plastic viscosity of meibum. The effects of meibum melting state, eyelid pressure and terminal duct diameter on meibum flow rates were then systematically investigated. ResultsThe melting state of meibum from liquid to solid was associated with an increase in the minimum yield stress and plastic viscosity that caused an exponential decrease in meibum flow. Modeling also established that there was a linear correlation between meibum flow rate and eyelid pressure needed to express meibum and the 4th power of the terminal duct radius. ConclusionsOur results suggest that changes in the melting state of meibum from fluid to solid, as well as changes in the radius of the terminal excretory duct and the force exerted by the eyelid can lead to dramatic decreases in the flow of meibum. Together these findings suggest alternative mechanisms for meibomian gland obstruction.

Evaluation of Ocular and Systemic Oxidative Stress Markers in Ocular Rosacea Patients.

To investigate oxidative stress markers in tears and serum of patients with ocular rosacea and to examine their association with both ocular surface parameters and cutaneous rosacea subtypes. This prospective study includes rosacea patients with ocular involvement and healthy controls. We performed ophthalmological examination of all participants and collected tear breakup time (TBUT), Schirmer, Meibomian gland dysfunction (MGD) and Ocular Surface Disease Index (OSDI) scores. We quantified the total antioxidant status (TAS), total oxidant status (TOS), and arylesterase (ARE) levels from tear and serum samples, and calculated the oxidative stress index (OSI). We also classified patients into phymatous, erythematotelangiectatic, papulopustular subtypes. We included 90 ocular rosacea patients and 30 healthy controls. Oxidative stress (TOS, OSI) levels were significantly higher (P < 0.01) and antioxidant levels (TAS, ARE) were significantly lower (P < 0.01) in both tear and serum samples of ocular rosacea patients as compared to controls. We found a significant positive correlation between the tear and serum values regarding oxidative stress parameters (P < 0.05). Besides, OSI was negatively correlated with TBUT and positively correlated with MGD score (meiboscore) and OSDI (P < 0.05). The Schirmer score was not correlated with OSI. No difference was found between the cutaneous subtypes with respect to TAS, TOS, ARE, and OSI results. In this study, we identified oxidative stress markers in the serum and tears of ocular rosacea patients and showed their correlation with clinical signs of MGD, suggesting that oxidative stress contributes to ocular rosacea pathogenesis and that oxidative stress could be an indicator of MGD severity.

The varied influence of ocular Demodex infestation on dry eye disease and meibomian gland dysfunction across different age groups

This study aimed to investigate the impact of ocular demodicosis on dry eye disease (DED) and meibomian gland dysfunction (MGD) across different age populations: young (20 to < 40), middle-aged (40 to < 60), and elderly (≥ 60), based on the retrospective medical chart review. In each age subgroup, Demodex infestation and its count were correlated with clinical parameters of DED and MGD. Among the total of 351 subjects, 52.7% had ocular demodicosis, with a mean of 2.31 ± 1.39 mites per four eyelashes (0.58 per lash) in a unilateral eye. In the age subgroup 1 (age < 40; N = 44), subjects with Demodex had significantly higher meibum quality grades. In subgroup 2 (40 ≤ age < 60; N = 122), subjects with Demodex had higher ocular surface disease index scores and higher MG expressibility grades. However, in subgroup 3 (age ≥ 60; N = 185), demographics and all parameters did not differ according to Demodex infestation. Moreover, the number of mites did not correlate with MGD severity in any of the subgroups. In conclusion, age may act as a significant confounding factor in the relationship between ocular Demodex infestation and clinical features of DED and MGD, despite older patients aged 60 years and above being at a higher risk of Demodex infestation and experiencing more severe MGD.

A cross sectional study to assess the severity of meibomian gland dysfunction and its association with dyslipidemia

Background: Studies have linked increased cholesterol esters in meibomian secretions to patients with meibomian gland dysfunction. Dyslipidemia has been linked to the development of MGD. This study of serum lipid profile in established cases of MGD. Methods: A cross sectional study was conducted in department of ophthalmology at Rajarajeswari medical college and hospital Kambipura, Bengaluru from January 2021 to June 2022. 75 study participants with clinical diagnosis of MGD were included. Results: The mean age of the study participants was found to be 55.97±14.019. Mild MGD grade was found in 32% and 26.7% of the study participants in the right eye and left eye respectively. Moderate MGD grade was 38.7% and 42.7% of the study participants in the right and left eye respectively. 4% each of the study participants had very severe MGD grade in the right and left eye respectively. Marx line grading of 1 was found in 40% and 46.7% of the study participants in the right eye and left eye respectively. Marx line grading of 2 was found in 54.7% and 36% of the study participants in the right and left eye respectively. Marx line grading of 3 was 5.3% and 17.3% of the study participants in right left eye respectively. severity of MGD grading of the study participants increases, the Lipid profile values also increases. The association was statistically significant between the MGD grading and lipid profile. Conclusions: MGD patients exhibit a higher degree of total cholesterol, LDL, lower degree of HDL in their serum lipid profiles than normal reference levels and the severity of MGD increases, the values of lipid profile increase. Elevated serum cholesterol was associated with MGD.

Exploring Signs and Symptoms Associated with Meibomian Gland Dysfunction for Use as Clinical Trial Endpoints.

Purpose: Dry eye disease is attributed to impaired tear production and/or evaporative dry eye. Evaporative dry eye is frequently associated with meibomian gland dysfunction (MGD). The objective of this study was to identify clinical study endpoints related to MGD. Methods: This 22-day, noninterventional, case-control clinical study involved three cohorts with increasing MGD severity: no MGD, mild/moderate MGD, and severe MGD. Symptoms were assessed with an ocular symptom questionnaire grading blurred vision, eye burning, eye dryness, eye pain, light sensitivity, eye itching, eye foreign body sensation, and overall ocular discomfort. Sign assessments included the maximum meibum quality score (MMQS), tear breakup time, Schirmer tear tests, biomicroscopy, and corneal staining. Signs and symptoms were compared between cohorts and study visits. Results: Seventy-five study participants were assigned to the cohorts (25 per cohort). MMQS scores increased with increasing MGD severity, reflecting the selection criteria for the cohorts. Between-visit scores showed a weighted kappa statistic of 0.72 indicating substantial agreement. Mean scores of all assessed symptoms increased with increasing MGD severity. Scores for symptoms showed moderate (κ = 0.41-0.60) to substantial (κ = 0.61-0.80) agreement between visits. Overall ocular discomfort demonstrated the strongest correlation with the MMQS. Conclusion: The MMQS was a reproducible sign of MGD showing good agreement with ocular symptoms. Overall ocular discomfort was well correlated with typical dry eye symptoms and could potentially be used as a single measure of MGD symptoms. The findings from this observational study may inform endpoints for future clinical trials. ClinicalTrials.gov NCT01979887.

Association between Dyslipidemia and Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis.

This study aimed to use meta-analysis to estimate the association between dyslipidemia and meibomian gland dysfunction. The following databases were searched: PubMed, Google Scholar, and Scopus. Case-control and cohort studies assessing the association between dyslipidemia and meibomian gland dysfunction were included. The association was assessed using odds ratios. Heterogeneity between studies was assessed with the χ2 statistic and degree of inconsistency. The quality of studies was assessed using the Newcastle-Ottawa Scale. The systematic review was registered on PROSPERO (ID: CRD42022347982). The systematic review included three case-control and two cohort studies. The odds of hypercholesterolemia and hypertriglyceridemia in meibomian gland dysfunction were 5.45 (95% confidence interval [CI], 1.65 to 17.95) and 3.28 (95% CI, 1.25 to 8.62), respectively. The odds of elevated serum low-density lipoprotein and reduced high-density lipoprotein in meibomian gland dysfunction were 2.72 (95% CI, 1.24 to 5.98) and 1.15 (95% CI, 0.74 to 1.79), respectively. The current study's limitation is that the effects of sex, age, and meibomian gland dysfunction severity on the association between dyslipidemia and meibomian gland dysfunction were not assessed. The current study suggests a significant association between dyslipidemia and meibomian gland dysfunction. This finding suggests that meibomian gland dysfunction diagnosis may call for dyslipidemia screening.

Evaluation of meibomian gland dysfunction in type 2 diabetes with dry eye disease: a non-randomized controlled trial

BackgroundThe purpose of this investigation was to evaluate the morphology and physiological function of the meibomian glands between type 2 diabetics with dry eye disease (DED) and control subjects. Doing so will help to better reveal the pathologic mechanisms of meibomian gland dysfunction (MGD) and DED in type 2 diabetes mellitus (T2DM).MethodsNinety subjects were divided into the following four groups: DM-DED group: T2DM patients with DED (n = 30); DM control group: DM patients without DED (n = 18); DED group: DED patients without DM (n = 26); and normal control group: normal subjects (n = 16). All participants administered the ocular surface disease index (OSDI) questionnaire, tear meniscus height (TMH), noninvasive Keratograph tear film break-up time (NIKBUT), Schirmer I test (SIT), corneal fluorescein staining (CFS), eyelid margin abnormality examinations, meibum quality and meibomian gland (MG) dropout evaluations. ResultsThe percentage of MG dropout in the upper and lower lids was significantly higher in the DM-DED group than the DED group (P < 0.05 or P < 0.01). However, there was no significant difference in other MG parameters between these two groups. Oppositely, Significant difference was observed in all of MG parameters except MG dropout in the lower lids comparing DM group with normal controls (P < 0.05 or P < 0.01). While the SIT values decreased in the DM-DED group compared to the DED group (P < 0.05), no significant differences were found in the values of other tear parameters. ConclusionsThe higher prevalence and increased severity of MGD was found in patients with both T2DM and DED compared to those only with DED. Trial registrationChinese Clinical Trial Registry ChiCTR1800019939, date of registration December 9, 2018, prospectively registered.

Meibomian Gland Dysfunction: A Route of Ocular Graft-Versus-Host Disease Progression That Drives a Vicious Cycle of Ocular Surface Inflammatory Damage

To investigate the role of aggressive meibomian gland dysfunction (MGD) in the immune pathogenesis of ocular graft-vs-host disease (GVHD). In mice, an allogeneic GVHD model was established by transferring bone marrow (BM) and purified splenic T cells from C57BL/6J mice into irradiated C3-SW.H2b mice (BM+T). Control groups received BM only. Mice were scored clinically across the post-transplantation period. MGD severity was categorized using the degree of atrophy on harvested lids. Immune disease was analyzed using flow cytometry of tissues along with fluorescent tracking of BM cells onto the ocular surface. In humans, parameters from 57 patients with ocular GVHD presenting to the Duke Eye Center were retrospectively reviewed. MGD was categorized using the degree of atrophy on meibographs. Immune analysis was done using high-parameter flow cytometry on tear samples. Compared with BM only, BM+T mice had higher systemic disease scores that correlated with tear fluid loss and eyelid edema. BM+T had higher immune cell infiltration in the ocular tissues and higher CD4+-cell cytokine expression in draining lymph nodes. BM+T mice with worse MGD scores had significantly worse corneal staining. In patients with ocular GVHD, 96% had other organs affected. Patients with ocular GVHD had abnormal parameters on dry eye testing, high matrix metalloproteinase-9 positivity (92%), and abundance of immune cells in tear samples. Ocular surface disease signs were worse in patients with higher MGD severity scores. Ocular GVHD is driven by a systemic, T-cell-dependent process that causes meibomian gland damage and induces a robust form of ocular surface disease that correlates with MGD severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery.

To describe the significance of meibomian gland dysfunction (MGD) in corneal refractive surgery and to describe available approaches to preoperative evaluation and treatment based on current research. There are several methods available for the evaluation and treatment of MGD. These are relevant for refractive surgeons to understand, as the presence of MGD preoperatively plays a role in the severity of MGD after corneal refractive surgery. Refractive surgery itself can exacerbate MGD. Treatment of MGD prior to surgery may have a meaningful impact on postoperative MGD. Surgeons should include meibomian gland assessment in the preoperative refractive evaluation and should treat MGD proactively prior to performing refractive surgery. Relevant information in this field is growing; additional prospectively designed studies are needed to further enhance our understanding.

Comparable meibomian gland changes in patients with and without ocular graft-versus-host disease after hematopoietic stem cell transplantation

PurposeTo compare the presentation and severity of meibomian gland dysfunction (MGD) in patients with and without chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MethodsThis prospective cross-sectional study included 79 patients (47 with coGVHD and 32 without) after allo-HSCT. All participants completed ocular surface disease index questionnaire, and received slit lamp, ocular surface interferometer, meibography and confocal microscopy examination. The prevalence and severity of MGD were compared between two groups and related factors were analyzed. Main outcome measures were lipid layer thickness (LLT) and meiboscore. ResultsSimilarly high prevalence of MGD was detected in coGVHD and non-coGVHD groups (87.2% vs 84.4%, P = 0.977). Among those with MGD, although patients without coGVHD had longer noninvasive break-up time [5.54 (2.87, 9.37) vs 2.29 (0.00, 3.82) s, P < 0.001], patients in two groups presented similarly decreased LLT (53.5 ± 22.3 vs 47.1 ± 25.2 nm, P = 0.286), increased meiboscore (2.7 ± 1.5 vs 3.5 ± 1.8, P = 0.060) and enlarged acinar unit area (1647.7 ± 942.9 vs 1808.8 ± 1211.5 μm2, P = 0.592). Meibomian gland inflammation and fibrosis were observed in both groups, but more predominant in coGVHD group. Results were consistent when patients within a comparable post-HSCT time interval were compared. Regression analysis revealed neither LLT nor meiboscore was associated with coGVHD severity. LLT was positively correlated with systemic immunosuppressant use (β = 12.0, P = 0.044), while meiboscore was positively correlated with lymphoma (β = 1.78, P = 0.040) and matched unrelated donor (β = 1.59,P = 0.008). ConclusionsMGD was common and evident in patients after allo-HSCT. MGD is not different between coGVHD and non-coGVHD patients except more inflammation and fibrosis in the former.

Lipid layer thickness decrease due to meibomian gland dysfunction leads to tear film instability and reflex tear secretion

Purpose To determine the clinical effects of ocular surface and Meibomian gland parameters on tear film stability among individuals with Meibomian gland dysfunction (MGD), those with aqueous deficient dry eye (ADDE), individuals with both conditions and normal controls. Methods Patients were divided into four groups: normal controls, patients with ADDE, patients with MGD, and patients who fulfilled diagnostic criteria for ADDE and MGD (Mixed Group). Data for ocular symptom score, lid margin abnormality, ocular staining, tear break-up time, meiboscore, and lipid layer thickness (LLT) measured by a Lipiview interferometer, Schirmer test, and MGD severity score were collected. Results A total of 109 patients (109 eyes) were evaluated. In patients with MGD, LLT was significantly lower than the ADDE patients. However, the Schirmer test value was the highest in the MGD group. The LLT negatively correlated with meiboscore and MGD severity score in the MGD group. Significant correlation between Schirmer test value and meiboscore was definite in the MGD group. Conclusions Tear fluid secretion is more increased and lipid layer thickness is more decreased in MGD patients than in ADDE patients. Decreased lipid layer thickness caused by MGD-related tear film instability may stimulate reflex tear secretion. The obstructive MGD is more prevalent than hypersecretary MGD. Key messages The tear film stability is affected by Mebomian gland dysfunction (MGD). The measurement of the tear film parameters including lipid layer thickness suggests that the obstructive MGD is more prevalent than hypersecretary MGD and the aqueous layer compensates the decreased lipid layer caused by MGD.