Meibomian Gland Function Research Articles

Protocol for a parallel assignment prospective, randomised, comparative trial to evaluate the safety and efficacy of intense pulsed light (IPL) combined with 3% diquafosol (DQS) ophthalmic solution in dry eye syndrome

IntroductionEvaporative dry eye (EDE) is common and can lead to ocular pain, decreased visual quality and reduced quality of life. Intense pulsed light (IPL) and 3% diquafosol ophthalmic solution have...

Novel treatment of chalazion using light-guided-tip intense pulsed light

We assessed the effectiveness of light-guided-tip intense pulsed light (IPL) with meibomian gland expression (MGX) in chalazion treatment. Ninety-five eyes with chalazion received a light-guided-tip IPL-MGX treatment (IPL-MGX group), and another 95 eyes with chalazion received incision with curettage treatment (Control group). Prior to IPL or incision, as well as 1 month after the final treatment, data were gathered pertaining to the lesion location and size, hyperemia, lesions regression or recurrence, and a comprehensive ophthalmic examination. The total size of the chalazia in the IPL-MGX group was significantly reduced after the final treatment, with an average resolution rate of 70.5%, which is comparable to excision surgery. A significant decrease in chalazion recurrence rate was apparent after treatment in the IPL-MGX group compared with control. Moreover, the IPL-MGX demonstrated significant advancements throughout noninvasive tear film breakup time (NIBUT) as well as meibum grade in comparison to baseline and those in the the Control group. The use of IPL-MGX was found to be an efficient therapy for reducing the size and recurring frequency of chalazia, as well as for improving the meibomian gland function. It may be considered as a first-line treatment for cases of primary or recurrent chalazia with inflammation.

Preoperative Treatment of Meibomian Gland Dysfunction with a Vectored Thermal Pulsation System Prior to Extended Depth of Focus IOL Implantation.

Patients implanted with a range-of-vision intraocular lens (IOL) (multifocal or extended depth of focus, EDOF) may be more susceptible to visual disturbances from poor tear film quality, and prophylactic treatment of meibomian gland dysfunction (MGD) has been recommended. The purpose was to evaluate whether vectored thermal pulsation (LipiFlow™) treatment prior to cataract surgery with a range-of-vision IOL safely improves postoperative outcomes. This is a prospective, randomized, open-label, crossover, multicenter study of patients with mild-to-moderate MGD and cataract. The test group underwent LipiFlow treatment prior to cataract surgery and implantation of an EDOF IOL, while the control group did not. Both groups were evaluated 3months postoperatively, after which the control group received LipiFlow treatment (crossover). The control group was re-evaluated 4months postoperatively. A total of 121 subjects were randomized, with 117 eyes in the test group and 115 eyes in the control group. At 3months after surgery, the test group had a significantly greater improvement from baseline in total meibomian gland score compared with the control group (P = 0.046). At 1month after surgery, the test group had a significant decrease in corneal (P = 0.04) and conjunctival (P = 0.002) staining compared to the control group. At 3months after surgery, the test group had significantly lower incidence of being bothered by halos compared with the control group (P = 0.019). The control group had a significantly lower incidence of being bothered by multiple or double vision compared with the test group (P = 0.016). After crossover, patients had significant improvement in vision (P = 0.03) and total meibomian gland score (P < 0.0001). No safety concerns or relevant safety findings were uncovered. Presurgical LipiFlow treatment of patients implanted with range-of-vision IOLs improved meibomian gland function and postoperative ocular surface health. This supports guidelines recommending proactive diagnosis and management of MGD in patients with cataracts to improve patient experience. The study was registered on www. gov (NCT03708367).

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.

Restoration of Meibomian Gland Functionality with Novel Mesenchymal Stem Cell-Derived Product “Derived-Multiple Allogeneic Proteins Paracrine Signaling (d-MAPPS)”: A Case Report

Abstract Meibomian gland dysfunction (MGD) results in the increased tear film osmolarity and leads to the development of dry eye disease. Results obtained in several experimental and clinical studies suggested that mesenchymal stem cells (MSCs) could promote repair and regeneration of injured meibomian glands. We recently developed a new biological product “derived-Multiple Allogeneic Proteins Paracrine Signaling (d-MAPPS)” which activity was based on the effects of immunosuppressive and trophic factors secreted by MSCs. Herewith, we report a case of MGD treated by d-MAPPS containing eye drops, demonstrating therapeutic potential of d-MAPPS in regeneration of injured meibomian glands and in the attenuation of MGD. D-MAPPS containing eye drops significantly attenuated MGD-related symptoms (foreign body sensation, burning, pain in the eye and eye fatigue) and remarkably improved quality of life. The analysis of meibomian glands demonstrated restoration of meibomian gland morphology, structure and function, after the 3-weeks of d-MAPPS based therapy. MGD patient did not report any adverse effects related to the d- MAPPS administration, indicating that d-MAPPS containing eye drops were safe for intraocular application.

Meibomian Gland Dysfunction in Primary Acquired Nasolacrimal Duct Obstruction.

This study was designed to investigate the influence of primary nasolacrimal duct obstruction (PANDO) on the structure and function of the Meibomian gland and to examine whether it is related to functional failure after dacryocystorhinostomy surgery. Medical records of patients diagnosed as PANDO from August 2021 to February 2022 were retrospectively studied. Results of slit lamp examination, lacrimal drainage test, tear break-up time, anterior segment optical coherence tomography, and meibography were collected. Tear meniscus height, tear break-up time, meiboscore, and lipid layer thickness of tear membrane were parameters compared between the eyes with complete PANDO and the control group. Medical records of 44 patients, therefore 88 eyes were collected, and there were 28 eyes with complete PANDO (total obstruction group), while normal eyes (control group) were 30. Mean tear meniscus height was significantly higher than that of the control group ( P value<0.001), but tear break-up time ( P value=0.322), lipid layer thickness ( P value=0.755), and meiboscore ( P value=0.268) were not significantly different. However, in the cases with moderate and severe meibomian gland destruction, the lipid layer thickness of the total obstruction group was significantly thinner than the control group. Lipid secretion of meibomian glands was less in eyes with PANDO than in eyes without PANDO, under moderate to severe meibomian gland destruction. It can lead to persistent epiphora after dacryocystorhinostomy due to a compensatory response against evaporative dry eye disease. Patients should be educated before the decision to undergo surgeries about the possibilities of persistent epiphora. Further studies are needed to prove the mechanism of meibomian gland function disturbance in PANDO.

A review on drug-induced dry eye disease.

Dry eye disease encompasses a broad range of etiologies and disease subtypes which have similar clinical manifestations. Medications can cause dry eye disease or symptoms of dryness as a side effect by either interfering with the lacrimal gland or meibomian gland function, or both, and by other mechanisms that affect the ocular surface homeostasis. This is important to know and recognize as eliminating the offending medication can reverse the symptoms and, in many cases, prevent further deterioration of the ocular surface inflammation. This review focuses on drugs like systemic isotretinoin and taxanes, which cause meibomian gland dysfunction; immune checkpoint inhibitors that cause lacrimal gland dysfunction; gliptins and topical antiglaucoma medications that cause cicatrizing conjunctivitis; and epidermal growth factor receptor inhibitors, fibroblast growth factor receptor inhibitors, and belantamab mafodotin, which cause mucosal epitheliopathy. Many of these medications, particularly the newer anticancer agents, have only recently been introduced for clinical use, and knowledge and awareness of their ocular side effects are still evolving. This review aims to update ophthalmologists on the drug-induced causes of dry eye disease or symptoms of dryness, which is avoidable by discontinuation of the incriminating agent or can be mitigated by reducing the dose or frequency of usage.

Staining characteristics of the lid margin

Background Vital stains are very important for evaluation of Marx line (ML) location, regularity, and lid wiper epitheliopathy. ML score can be used to assess Meibomian gland function, whereas lid wiper epitheliopathy is considered an early indicator for tear film instability. Aim To evaluate staining characteristics of the lid margin in different disease conditions, such as dry eye, Meibomian gland dysfunction (MGD), and eyelid malposition using vital stains. Patients and methods A total of 80 patients aged between 40 and 60 years were included in this study. Patients were already diagnosed as having dry eye, MGD, and eyelid malposition (ectropion and entropion). Vital stains (fluorescein, rose Bengal, and Lissamine green) were used to assess the lid wiper area and ML position in these diseases. Results The included 80 participants comprised 44 females and 36 males aged from 40 to 60 years, with mean±SD of 45.10 ± 5.42 years for normal participants, and it was 47.35 ± 6.57 years for dry eye participants. ML was straight in 75% of normal group, but it was irregular in 65% of the dry eye group, 100% of the malposition group, and 70% of MGD group. Lid wiper epitheliopathy was mild degree in one-third of normal participants. In dry eye participants, it was moderate and severe (45% for each). Conclusion ML is irregular and moved gradually anterior to the eyelid margin with different diseases such as dry eye, MGD, and eyelid malposition. Lid wiper epitheliopathy provides information about the location of ML, and it can be easily seen by using the vital staining, and it is useful in the diagnosis of tear film instability.

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.

Meibomian gland dysfunction patients benefit in ocular parameters and tear chemokines after thermal pulsation treatment.

Objectives: To investigate the effect of thermal pulsation treatment on meibomian gland function, ocular parameters and tear inflammatory cytokines compared with the warm compress group. Methods: Twenty-five participants with MGD underwent a 12-minute thermal pulsation treatment, while 25 participants with MGD underwent manual warm compress treatment. MGD related parameters, including meibomian gland function (MGE, MQ and lid margin), tear stability (NIKBUT, FBUT and LLT), tear secretion (SIT, and TMH), were examined and OSDI questionnaire was also obtained. Tear chemokines (MIG, IFN-γ, IL-8, IP-10 and MCP-1) were examined and analyzed the correlations with MGD related parameters and OSDI. Results: Compared with warm compress subjects, OSDI, lid margin and tear stability were found improved more in thermal pulsation treatment at 3 months (OSDI: *p = 0.014, lid margin: *p = 0.021, LLT: **p = 0.008, CFS: *p = 0.028). The level of IP-10 and MIG decreased more in thermal pulsation group than in warm compress group (IP-10: *p = 0.021, MIG: *p = 0.039). IP-10 was positively correlated with MQ (r = 0.522, *p = 0.037) and negatively correlated with tear stability (r = -0.613, **p = 0.002), and OSDI was only positively correlated with IL-8 (r = 0.679, ***p < 0.001). The decrease of MIG was positively correlated with less corneal epithelium injury (r = 0.557, **p = 0.006) and meibograde (r = 0.49, *p = 0.019). Conclusions: Thermal pulsation treatment obviously improved MGD probably by attenuating tear CXCL chemokines in ocular surface of MGD patients, which demonstrated an efficacy and well-tolerated therapy in clinical.

Research progress on the pathogenesis of diabetes-related dry eye

In recent years, with the further understanding of medical circles on diabetic ocular complications, the ocular surface abnormalities of diabetes has drawn increasing concerns. Nearly 50% of diabetic patients suffer from dry eye symptoms. The main manifestations of diabetes related dry eye were abnormal lacrimal secretion, poor lacrimal stability, decreased corneal sensitivity, persistent corneal epithelial defect and even corneal ulcer, which were mainly related to the changes of structure and function of lacrimal gland, the decrease of goblet cells in conjunctiva, the abnormality of meibomian gland function and the degeneration of corneal nerve caused by diabetes. In this paper, we summarized and analyzed the recent research progress on the effect of diabetes on lacrimal film, corneal innervation and lacrimal gland innervation, and the correlation between oxidative stress, advanced glycation end products and diabetes-related dry eye, to explore the pathogenesis of diabetes-related dry eye and to provide reference for clinical diagnosis, treatment and research.

Application of orthokeratology on myopia control and its effect on ocular surface and meibomian gland function in Chinese myopic adolescents.

This study aimed to investigate the influence of orthokeratology (OK) on myopia control and ocular surface and meibomian gland function in myopic adolescents. A prospective study was conducted over a 12-month period. The subjects were classified into two groups, namely, the OK lens group and the frame glasses control group. Axial length, corneal curvature, ocular surface, and meibomian gland parameters were measured at baseline, 1, 3, 6, and 12 months after wearing OK lenses. The axial length growth rate in the OK group was significantly slower than in the control group (P < 0.01). The naked eye vision and the ocular surface disease index (OSDI) scores recorded 1, 3, 6, and 12 months after wearing OK lenses were significantly higher than the scores recorded before wearing OK lenses. There was no significant difference in other ocular parameters at each follow-up time point compared with pre-wearing (P > 0.05). After using the OK lens for 6 months, the OSDI score and corneal fluorescein staining (CFS) score increased significantly (P < 0.001), but there were no significant differences in other parameters among the groups. No infectious keratitis occurred during the study. These results provide evidence that the use of OK lenses can control the axial growth and progress rate of myopia compared with frame glasses. During the 12-month follow-up, although wearing OK lenses may have aggravated dry eye symptoms, each patient's ocular surface and meibomian gland function did not change significantly, indicating that the use of OK lenses is a relatively safe modality for the control of myopia in adolescents.

Analysis of Cytokine Levels in Meibum and Clinical Correlations with Meibomian Gland Dysfunction.

This study is aimed at investigating the difference of meibum chemokines in MGD subjects with different degrees of MGD and the correlations of meibum chemokines with ocular surface parameters. Twenty MGD subjects (MQ score > 8) and twenty MGD subjects (MQ score ≤ 8) were enrolled to examine ocular surface parameters, including meibomian gland function (MGE, MQ meibograde, and lid margin), tear stability (NIKBUT, FBUT, and LLT), tear secretion (SIT and TMH), OSDI questionnaire, and CFS. These subjects also obtained meibum samples, and then meibum chemokines (MIG, IFN-γ, IL-8, IP-10, and MCP-1) were examined and analyzed the correlations with ocular surface parameters. MIG, IP-10, and MCP-1 were found clearly elevated in MGD subjects with higher MQ score than that in MGD subjects with low MQ score (MIG: p = 0.038, IP-10: p = 0.019, MCP-1: p = 0.040). The meibomian function was found mostly positively correlated with level of MIG (MGE: r = 0.600, p < 0.001; MQ: r = 0.579, p < 0.001) and IP-10 (MGE: r = 0.719, p < 0.001; MQ: r = 0.601, p < 0.001). The tear stability was found negatively correlated with the level of MIG (NIKBUT: r = -0.438, p = 0.005; LLT: r = -0.464, p = 0.003) and MCP-1 (NIKBUT: r = -0.425, p = 0.006; LLT: r = -0.761, p < 0.001). The OSDI was positively correlated with IL-8, IFN-γ, and MIG. Chemokines in meibum were significantly evaluated in MGD subjects suffering from severe meibomian gland quality. These findings indicate that chemokines play roles in the pathogenesis of MGD, and molecules targeted by chemokines may develop as novel agents for MGD therapy, perhaps through inhibiting inflammation in meibomian glands and microvascular in the eyelid margin.

Induction of meibocyte differentiation by three-dimensional, matrigel culture of immortalized human meibomian gland epithelial cells to form acinar organoids

PurposeRecent studies have shown that two-dimensional (2D) culture of primary rabbit and immortalized human meibomian gland epithelial cells (iHMGEC) do not recapitulate normal meibocyte differentiation and fail to express critical enzymes necessary for synthesis of meibum lipids. The purpose of this study was to test the hypothesis that 3D-spheroid culture of iHMGEC can facilitate meibocyte differentiation and induce the expression of acyl-CoA wax-alcohol acyltransferase 2 (AWAT2), shown to be required for synthesis of meibum wax esters. MethodsiHMGEC were suspended in matrigel/basement membrane matrix and grown in proliferation media to form distinct cell clusters or spheroids. Cells were then treated with serum-free, differentiation media (advanced DMEM/F12) with and without FGF10 and synthetic agonists for the nuclear lipid receptor, peroxisome proliferator activator receptor gamma (PPARγ). Cells were then evaluated for differentiation markers using western blotting, immunocytochemistry (ICC) and real-time PCR. Control cells were grown in standard 2D culture systems. ResultsUnder proliferative conditions, 3D culture induced the formation of KRT5+ spheroids that contained a Ki67+/P63+ undifferentiated, basal cell population. When spheroids were switched to differentiation media containing PPARγ agonists, two different organoid populations were detected, a KRT6low population that was AWAT2+/PPARγ+ and a KRT6high population that was AWAT2-/PPARγ-, suggesting that iHMGEC exhibit a dual differentiation potential toward either a ductal or meibocyte organoid phenotype. ConclusionThe 3D culturing of iHMGEC can induce the formation of both meibocyte and ductal organoids and may thus serve as a better in vitro model system for studying the regulatory mechanisms controlling meibomian gland function.

Dry eye-related quality of life among type 2 diabetes patients: a hospital-based cross-sectional study

ABSTRACT Background To investigate the impact of dry eye syndrome (DES) on dry eye-related quality of life (QoL) in patients with type 2 diabetes. Research design and methods Evaluation of DES included assessment of meibomian gland function, tear breakup time (TBUT), Schirmer test, fluorescein ocular surface staining, and Ocular Surface Disease Index (OSDI) scores. DES diagnosis was based on OSDI score ≥13, TBUT < 10s, and fluorescein staining. Results After adjusting for age, duration of diabetes, drug usage, and comorbidities, severity of DES symptomatology and signs resulted in poorer QoL of patients when comparing cases and controls. TBUT, meibum quality, and ocular surface staining were the objective clinical tests that significantly correlated with QoL. Poor QoL was also associated with the presence of eyelash and eyelid anomalies (eyelash: aOR = 2.58, CI = 1.49–4.47, p = 0.001; eyelids: aOR = 1.66, CI = 1.01–2.71, p = 0.04). Patients who had been previously diagnosed and treated for DES registered improved QoL measures. Conclusions Symptoms or clinical signs of DES resulted in poorer QoL in a clinical sample of type 2 diabetes patients, stressing the need for clinicians to evaluate such signs and symptoms in order to improve QoL.

Impact of Air Pollution on the Ocular Surface and Tear Cytokine Levels: A Multicenter Prospective Cohort Study

PurposeTo assess air pollution-induced changes on ocular surface and tear cytokine levels.MethodsAs a prospective multicenter cohort study, 387 dry eye disease (DED) participants were recruited from five provinces in China and underwent measurements of ocular surface disease index (OSDI), Schirmer’s I test (ST), tear meniscus height (TMH), tear film break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland (MG) function, and tear cytokines. The associations between ocular surface parameters and exposure to particulate matter (PM), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2) for 1 day, 1 week, and 1 month before the examination were analyzed in single- and multi-pollutant models adjusted for confounding factors.ResultsIn the multi-pollutant model, the OSDI score was positively correlated with PM with diameter ≤2.5 μm (PM2.5), O3, and SO2 exposure [PM2.5: β (1 week/month) = 0.229 (95% confidence interval (CI): 0.035–0.424)/0.211 (95% CI: 0.160–0.583); O3: β (1 day/week/month) = 0.403 (95% CI: 0.229–0.523)/0.471 (95% CI: 0.252–0.693)/0.468 (95% CI: 0.215–0.732); SO2: β (1 day/week) = 0.437 (95% CI: 0.193–0.680)/0.470 (95% CI: 0.040–0.901)]. Tear secretion was negatively correlated with O3 and NO2 exposures but positively correlated with PM2.5 levels. Air pollutants were negatively correlated with TBUT and positively related with CFS score. Besides SO2, all other pollutants were associated with aggravated MG dysfunction (MG expression, secretion, and loss) and tear cytokines increasement, such as PM2.5 and interleukin-8 (IL-8) [β (1 day) = 0.016 (95% CI: 0.003–0.029)], PM with diameter ≤10 μm (PM10) and IL-6 [β (1 day) = 0.019 (95% CI: 0.006–0.033)], NO2 and IL-6 [β (1 month) = 0.045 (95% CI: 0.018–0.072)], among others. The effects of air pollutants on DED symptoms/signs, MG functions and tear cytokines peaked within 1 week, 1 month, and 1 day, respectively.ConclusionIncreased PM2.5, O3, and SO2 exposures caused ocular discomfort and damage with tear film instability. PM10 exposure led to tear film instability and ocular injury. PM, O3, and NO2 exposures aggravated MG dysfunction and upregulated tear cytokine levels. Therefore, each air pollutant may influence DED via different mechanisms within different time windows.

The influence of congenital and developmental cataract surgery on the ocular surface in a six-month follow-up prospective clinical study

BackgroundThe purpose of this study was to identify changes in tear film function and meibomian gland function in children after congenital/developmental cataract surgery.MethodsThis study enrolled 16 eyes of 16 congenital/developmental cataract patients (mean age: 8.05 ± 1.43 years) who underwent cataract surgery and 16 eyes of 16 normal volunteers (mean age: 8.31 ± 2.18 years). Clinical assessments were conducted preoperatively and at 1 week, 1, 3 and 6 months postoperatively. Symptom questionnaires, non-invasive tear film break-up time, tear meniscus height, corneal fluorescein staining, lid margin abnormality, meibomian gland expressibility, and meibography were assessed.ResultsThe ocular symptom score was significantly higher in congenital/developmental cataract patients compared to normal controls during the 5 visits (P = 0.009). And the average non-invasive tear film break-up time was significantly lower in congenital/developmental cataract patients compared to normal controls (P = 0.017). The first non-invasive tear film break-up time and average non-invasive tear film break-up time were lowest at 1 month postoperatively compared to baseline levels (P = 0.008 and P = 0.012, respectively). The lid margin score of the upper eyelid was significantly higher in congenital/developmental cataract patients compared to normal controls at 1 week postoperatively (P = 0.027). The meibum expressibility score decreased significantly during the 5 visits (P = 0.024). No significant difference was observed in meibomian gland tortuosity, meibomian gland width, meibomian gland area and meibomian gland length between the congenital/developmental group and normal controls preoperatively and at 6 months postoperatively (P > 0.05).ConclusionTear film stability and meibomian gland function are worsened transiently after congenital/developmental cataract surgery without accompanying meibomian gland morphological changes.

A clinical study of thunder-fire moxibustion combined with meibomian gland massage in treatment of meibomian gand dysfunction

To observe the effect of thunder-fire moxibustion combined with meibomian gland massage in improving meibomian gland dysfunction (MGD) and explore its mechanism. Seventy-two MGD patients with 144 eyes in the Jinhua Hospital of Traditional Chinese Medicine from February 2019 to January 2021 were selected and randomly divided into an experimental group (n=36,72 eyes) and a control group (n=36, 72 eyes). Patients in the control group received 0.1% fluo-rometholone eye drops and 0.1% sodium hyaluronate eye drops, 1-2 drops per time, four times per day, and the meibomian glands were massaged once per day. Patients in the experimental group received additional thunder-fire moxibustion on the basis of the treatment of the control group, 10 cones per time, once per day. One month after treatment, meibomian gland function was assessed, and the levels of interleukin-6 (IL-6) and prostaglandin E2(PGE2) in tears were detected. After treatment, the scores of Ocular Surface Disease Index, meibomian hyperemia, meibomian gland opening, meibomian gland loss, and meibomian gland secretion function were lower than those before treatment in the two groups, and the scores of the experimental group were lower than those of the control group (P<0.05). After treatment, the tear break-up time and tear meniscus height were higher than those before treatment in the two groups, which were higher in the experimental group than those in the control group (P<0.05). The post-treatment levels of IL-6 and PGE2 were lower than those before treatment in the two groups, and the levels in the experimental group were lower than those in the control group (P<0.05). Thunder-fire moxibustion combined with meibomian gland massage can significantly improve the function of the meibomian glands and lower the levels of IL-6 and PGE2 in tears.

Structural and Functional Evaluation of Meibomian Glands and Its Correlation With Dry Eye Parameters in Stevens-Johnson Syndrome

To evaluate the structural and functional changes of the meibomian gland and correlate with subjective and other objective dry eye parameters in Stevens-Johnson syndrome (SJS) patients. Prospective cross-sectional study. This study recruited 60 patients (120 eyes) with SJS and chronic ocular sequelae. All patients underwent evaluation with a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear osmolarity, Keratograph 5M, LipiView, Schirmer's 1, corneal staining, Meibum Expression score (MES, 0-3), and Meibum Quality score (MQS, 0-3). The meibomian gland dropout area (meiboscore) was calculated for both lids and graded on a 4-point scale from 0 to 3. The mean age of patients (n=60) was 31.08 ± 12.94 years; 25 were males. The commonest cause for SJS, in 51 patients (85%), was drug reaction. The mean tear osmolarity, lipid layer thickness (LLT), Schirmer's test-1, and tear break-up time was 322.70 ± 17.82 mOsm/L, 53.07 ± 27.0 nm, 6.62 ± 5.74 mm, 3.38 ± 1.90 seconds, respectively. Out of 240 eyelids (both upper and lower), 160 (65%) eyelids revealed severe meibomian gland loss. The mean upper and lower lid gland loss was 77.36 ± 28.82% and 76.65 ± 29.33%, respectively, Seventy-four eyelids (61%) had no expressible glands. Meiboscore showed positive correlation with SPEED (P < .001), corneal staining scores (P < .001), MES (P < .001), and MQS (P < .001). The LLT negatively correlation with SPEED (P < .01), meiboscore (P < .001), MES (P < .01), and MQS (P < .001). Significant alterations in anatomical and functional aspects of the meibomian gland are seen in SJS. The high meiboscore, MES, MQS, and decreased LLT contributed to the worsening dry eye state, as seen by their correlation with other dry eye parameters. This study highlights the need to evaluate meibomian gland structure and function in patients with chronic ocular sequelae of SJS.

Analysis of Ocular Surface Characteristics and Incidence of Dry Eye Disease in Systemic Lupus Erythematosus Patients Without Secondary Sjögren's Syndrome.

ObjectiveTo investigate the differences in ocular surface characteristics, tear film quality, and the incidence of dry eye disease (DED) between Systemic Lupus Erythematosus (SLE) patients and healthy populations.MethodsThis age and gender-matched cross-sectional study included 96 SLE patients without secondary Sjögren's syndrome (SS) and 72 healthy subjects. The Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), non-invasive tear film breakup time (NIKBUT), meibography, and tear film lipid layer grade were assessed. A receiver operative characteristic (ROC) curve was constructed to evaluate the predictive value of risk factors.ResultsCompared with the control subjects, a significantly greater proportion of SLE patients met the TFOS DEWS II DED diagnostic criteria (34.3 vs. 18.1%, P = 0.019). SLE patients without SS had higher OSDI scores [10.0 (4.5,18.0) vs. 5.0 (2.5,11.9), P < 0.001], and shorter NIKBUT [9.6 (6.6,15.0) vs. 12.3 (8.4, 15.8), P = 0.035]. Furthermore, TMH, Tear film lipid layer grade, and Meibomian gland (MG) dropout in SLE patients were worse than those in control subjects (all P < 0.05). For ROC analysis, the area under curve (AUC), sensitivity and specificity of prediction were 0.915, 75.8 and 92.1% for the combination of SLE disease activity index (SLEDAI), age and NIKBUT.ConclusionsSLE patients without SS exhibited a higher risk for DED than healthy subjects, and the poorer Meibomian gland function in SLE patients may potentially contribute to the development of DED. The combined parameters of SLEDAI, age and NIKBUT showed a high efficiency for the diagnosis of DED in SLE patients, with practical clinical applications.