Meibomian Gland Research Articles

Due to the lack of quality-controlled quantitative data on meibomian gland (MG) morphology in children and adolescents, this study aims to establish a Children and Adolescents Meibomian Gland (CAMG) dataset. A total of 1114 quality-controlled upper eyelid infrared images were collected from 730 children and adolescent subjects using the Oculus Keratograph 5M. Images underwent preprocessing and multi-stage expert quality control screening before segmentation. Morphological parameters including gland area, gland dropout ratio, gland length and width, number of glands, and total glands ratio were extracted using an AI model. The dataset, comprising images, annotations, and demographic information, is openly accessible on Figshare, with AI model codes available on GitHub to support research reproducibility and algorithm optimization. The dataset includes 1114 high-resolution quality-controlled upper eyelid images from 730 subjects (mean age 11.80 ± 2.39years; 46.77% male), accompanied by AI-assisted segmentation annotations and corresponding morphological measurements. The U-Net segmentation model achieved an accuracy of 97.49%, a Dice coefficient of 89.72%, and an intersection over union (IoU) of 81.67%. Quantitative analysis revealed that MG parameters remained relatively stable in adolescents compared to children. Females exhibited significantly wider and larger MGs than males. Similar sex-related differences were also observed in the central five MGs. Males exhibited a higher MG count compared to females. CAMG is a publicly available MG dataset for children and adolescents to support AI-based individualized clinical assessments. The dataset's transparent quality control processes establish a foundation for epidemiological research, promoting cross-institutional collaboration and AI-driven advancements in ophthalmology.

Background and Objectives: Dry eye disease (DED) is a multifactorial ocular surface disease that markedly diminishes quality of life. Although diabetes mellitus is well-known for its retinal consequences, anterior segment symptoms including dry eye disease are often overlooked. Chronic hyperglycemia causes metabolic, neurovascular, and immunological changes that undermine tear film stability, corneal innervation, and ocular surface integrity. This review seeks to consolidate existing knowledge regarding the concealed impacts of diabetes on ocular surface homeostasis, highlighting processes, diagnostic difficulties, and treatment prospects. Materials and Methods: A narrative review of the literature was performed by searching PubMed for publications from January 2020 to July 2025 using the terms “diabetic dry eye,” “hyperglycemia AND ocular surface,” “tear proteomics AND diabetes,” “corneal nerves AND diabetes,” and “neurotrophic keratitis.” Eligible studies were experimental research, clinical trials, and translational investigations concerning tear film function, corneal neuropathy, inflammatory indicators, or lacrimal gland dysfunction in diabetes. The exclusion criteria were non-English language, lack of primary data, and inadequate methodological description. Results: Hyperglycemia compromises lacrimal gland functionality, modifies lipid secretion from Meibomian glands, and diminishes corneal nerve density, resulting in neurotrophic deficits. Inflammatory cytokines and oxidative stress compromise epithelial integrity, but proteome alterations in tears serve as sensitive indicators of disease. Diagnosis is impeded by corneal hypoesthesia, resulting in a disconnection between symptoms and findings. Progress in imaging, proteomics, and artificial intelligence may facilitate earlier detection and improved risk assessment. Novel therapeutics, such as neurotrophic drugs, antioxidants, and customized anti-inflammatory approaches, show promise but remain under clinical evaluation. Conclusions: Diabetes-related dry eye disease is a multifaceted and underappreciated condition influenced by systemic metabolic dysfunction. The ocular surface may act as an initial indicator for systemic disease load. Narrative synthesis emphasizes the necessity for customized diagnostic instruments, individualized treatment approaches, and collaborative management. Reconceptualizing diabetic dry eye disease within the context of systemic metabolic care presents prospects for precision medicine strategies that enhance both ocular and systemic results.

Purpose To assess the effectiveness of Systane COMPLETE in reducing symptoms of ocular dryness and improving Meibomian Gland (MG) Score in subjects with mild to moderate dry eye disease (DED). Methods A prospective, interventional, single-center, single-arm study was conducted including cases of mild to moderate DED. Participants were prescribed a topical lipid-based combination of propylene glycol (PG) and hydroxypropyl guar (HPG) (Systane ® COMPLETE), administered four times daily for 30 days. Dry eye assessment parameters, Meibo score, and Ocular Surface Disease Index (OSDI) questionnaire responses were obtained before and after treatment. Results A total of 105 cases with mild to moderate DED were included in the study. Statistically significant improvements were observed in tear breakup time (TBUT) (p<0.0001), Schirmer’s test (p<0.0001), lipid layer thickness (LLT) (p<0.0001), tear meniscus height (TMH) (p=0.0002), non-invasive breakup time (NIBUT) (p<0.0001), OSDI (p<0.0001), upper lid meibomian gland score (p=0.02), corneal staining score (p<0.0001). The change in Meibo score was not statistically significant (p=0.19). Conclusion A lipid-based nanoemulsion of PG–HPG helps in improving the objective parameters and symptoms of DED. Additionally, it may support improved meibomian gland function.

Purpose: Refractive surgery may exacerbate the existing dry eye symptoms in patients with dry eye syndrome. Therefore, we explore the therapeutic and protective effects of using optimal intense pulsed light (IPL) therapy combined with meibomian gland expression (MGX) before and after surgery on post-laser corneal refractive surgery dry eyes. Methods: This was a prospective, self-controlled, single-center clinical trial. Using optimal IPL therapy and MGX, a total of 68 patients with mild-to-moderate evaporative dry eye or meibomian gland dysfunction who underwent refractive surgery received 2 sessions of treatment. The treatment was administered once a week preoperatively and once a week postoperatively. Baseline measurements were taken before optimal IPL therapy and MGX, and the parameters were assessed at 1 week and 1 month after surgery. Results: Out of 68 patients, 54 patients received small-incision lenticule extraction (SMILE), while 14 patients received femtosecond laser-assisted in situ keratomileusis (FS-LASIK) (results primarily reflect SMILE outcomes due to sample imbalance). In the SMILE group, significant improvement was already observed in uncorrected/corrected distance visual acuity (P = 1.42 × 10-3), meibomian gland expressibility score (MGYSS) (P = 0.01), and meibum yielding secretion score (MGS) (P = 5.39 × 10-4) between 1 week before and after the surgery. First noninvasive breakup time (NIBUTf) (P = 8.98 × 10-3), average noninvasive breakup time (NIBUTav) (P = 2.30 × 10-4), and meibomian gland dropout score (bottom) (P = 9.05 × 10-3) were observed to have significant improvement till 1 month after the surgery. Patients in the FS-LASIK group exhibited a comparable trend of change. Conclusion: IPL treatment combined with MGX may improve ocular discomfort and dry eye symptoms in MGYSS, MGS, NIBUTf, NIBUTav, and meibomian gland dropout score (bottom) for patients with post-laser corneal refractive surgery dry eyes in short term.

TFOS DEWS III: Digest.

TFOS DEWS III: Management and Therapy.

Abnormalities in the tear film lipid layer, which plays a critical role in preventing water evaporation and protecting the corneal surface, lead to dry eye disease. The lipids in this layer include both meibum lipids (from the meibomian glands) and phospholipids of other origins. Meibum lipids include cholesteryl esters, wax monoesters, wax diesters (WdiEs), (O-acyl)-ω-hydroxy fatty acids (OAHFAs), and cholesteryl OAHFAs. Nonetheless, the exact composition of these lipid classes remains largely unclear. Here, we analyze the composition of cholesteryl esters, wax monoesters, WdiEs, OAHFAs, cholesteryl OAHFAs, phosphatidylcholines, and sphingomyelins in human meibum and tears using multiple reaction monitoring mode liquid chromatography-tandem mass spectrometry, which is highly sensitive, selective, and quantitative. This revealed that the WdiEs in meibum and tears fall within the type 1ω and 2ω classes. Among the lipids examined, the type 1ω WdiEs in particular comprised diverse species. The lipid composition of most of the lipid classes, except for the phosphatidylcholines, was similar in meibum and tears. The findings of this comprehensive lipid analysis contribute to elucidating the overall composition of human meibum and tear lipids.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-23048-1.

Dupilumab, approved for treating moderate-to-severe atopic dermatitis (AD), has been linked to a group of ocular surface adverse effects collectively called dupilumab-associated ocular surface diseases (DAOSDs). Although DAOSDs have been described in various populations, data regarding age- and sex-related differences in Latin American cohorts are scarce. This study aimed to describe the frequency and clinical features of DAOSDs in Colombian patients with AD, with a particular focus on variations by age and sex. We conducted a cross-sectional study of 56 patients with AD receiving dupilumab. A single ophthalmologist assessed ocular surface parameters, including tear break-up time, superficial punctate keratitis (SPK), and Meibomian gland dysfunction. Conjunctivitis was defined as the appearance of new symptoms after treatment onset and conjunctival hyperemia. Pre- and post-treatment symptoms were compared, and associations with age and sex were analyzed. Conjunctivitis was observed in 32.1% of patients. Pruritus (75%) and redness (53.6%) were the most frequent symptoms. Meibomian gland dysfunction and SPK were present in 46.4% and 41.1%, respectively. No sex-related differences were found. Patients aged ≥20 years showed significantly higher rates of symptoms, MGD, and SPK. DAOSDs were frequent, particularly in older patients, supporting the need for early ophthalmologic evaluation.

This study aimed to investigate the differential impairment of meibomian glands (MGs) in the upper and lower eyelids among postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO). Additionally, we evaluated the correlations between MG morphological and functional parameters and clinical indicators of tear film stability. A total of 115 eyes from 115 postmenopausal women with PANDO and 115 eyes from 115 matched control subjects were enrolled in the study. Upper and lower MG loss, and non-invasive tear meniscus height (NITMH) were evaluated using the Keratograph 5M. Tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and Marx' lines were all examined using a slit-lamp biomicroscope. Compared to controls, the PANDO group exhibited significantly higher MG loss scores in both the upper (p = 0.045) and lower (p = 0.036) eyelids, and worse meibum quality in the upper eyelids (p = 0.049). Marx's lines scores were significantly more severe in the PANDO group for both eyelids (upper: p < 0.001; lower: p = 0.02). Within the PANDO group, the MG loss score was significantly higher in the upper eyelid compared to the lower eyelid (p < 0.001). The meibum grade score also showed a significantly higher value in the upper eyelid relative to the lower eyelid (p = 0.045). In contrast, the Marx's lines score was significantly lower in the upper eyelid than in the lower eyelid (p = 0.032). Furthermore, the meibum grades of both the upper (p = 0.035) and lower (p = 0.001) eyelids demonstrated a negative correlation with TBUT, but no significant association was observed with CFS. However, no correlation was found between MG loss in either eyelid and TBUT or CFS. Postmenopausal women with PANDO show greater impairment in the upper MGs than in the lower MGs.This pattern may be a distinctive feature of ocular surface damage in this population. These findings provide new insights into PANDO-related ocular changes and may inform clinical assessment and management.

In recent years, numerous advanced image segmentation algorithms have been employed in the analysis of meibomian glands (MG). However, their clinical utility remains limited due to insufficient integration with the diagnostic and grading processes of meibomian gland dysfunction (MGD). To bridge this gap, the present study leverages three state-of-the-art deep learning models—DeepLabV3+, U-Net, and U-Net++—to segment infrared MG images and extract quantitative features for MGD diagnosis and severity assessment. A comprehensive set of morphological (e.g., gland area, width, length, and distortion) and distributional (e.g., gland density, count, inter-gland distance, disorder degree, and loss ratio) indicators were derived from the segmentation outcomes. Spearman correlation analysis revealed significant positive associations between most indicators and MGD severity (correlation coefficients ranging from 0.26 to 0.58; p &amp;lt; 0.001), indicating their potential diagnostic value. Furthermore, Box plot analysis highlighted clear distribution differences in the majority of indicators across all grades, with medians shifting progressively, interquartile ranges widening, and an increase in outliers, reflecting morphological changes associated with disease progression. Logistic regression models trained on these quantitative features yielded area under the receiver operating characteristic curve (AUC) values of 0.89 ± 0.02, 0.76 ± 0.03, 0.85 ± 0.02, and 0.94 ± 0.01 for MGD grades 0, 1, 2, and 3, respectively. The models demonstrated strong classification performance, with micro-average and macro-average AUCs of 0.87 ± 0.02 and 0.86 ± 0.03, respectively. Model stability and generalizability were validated through 5-fold cross-validation. Collectively, these findings underscore the clinical relevance and robustness of deep learning-assisted quantitative analysis for the objective diagnosis and grading of MGD, offering a promising framework for automated medical image interpretation in ophthalmology.

We aimed to evaluate the rate and determinants of reoperation after age-related cataract surgery and its potential risk factors. In this retrospective case-cohort study conducted at a tertiary eye hospital, Tehran, Iran, a representative sample of patients with cataract surgery from March 2017 to March 2021 was randomly selected from the hospital's medical records and reviewed for returns to the operating room during the first year after the procedure. Demographics, ocular characteristics, and operative factors of patients with reoperation were reviewed, and 3 randomly selected patients with a history of the same-day surgery for each reoperation case were designated as the controls. Potential risk factors were compared using multivariable logistic regression. Among the included 4666 surgery records, 70 reoperations related to 63 eyes (1.52%) were detected, with the reoperation rates of 0.75% for attendings and fellowship surgeons, and 3.57% for residents in training. Aphakia (20.0%), endophthalmitis (15.7%), and rhegmatogenous retinal detachment (14.3%) were the most common reasons for reoperations. After adjusting for potential confounders among the 70 reoperations and 211 controls, posterior capsular rupture (PCR), blepharitis and/or meibomian gland dysfunction (MGD), and axial length < 22.0 or > 24.5mm were significantly associated with reoperation. The total reoperation rate was 1.52%. PCR was a major determinant of these reoperations. Other factors included axial length < 22.0 or > 24.5mm and pathologies with high impact on the ocular surface, like MGD and blepharitis.

PurposeThis study investigated the efficacy of automated ocular thermography metrics for the screening of dry eye disease (DED).MethodsThis was a prospective study that enrolled 20 participants with DED, sex- and age-matched to 20 non-DED controls. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 (DEQ5), noninvasive tear-break-up time (NITBUT), tear meniscus height (TMH), meibomian gland dysfunction (MGD) score, and corneal staining were measured in a screening visit. The DED group was defined as: OSDI score of ≥13 or DEQ-5 score of ≥6, and DED signs in at least one eye (corneal/conjunctival/lid margin staining, NITBUT <5 seconds, tear film osmolarity ≥308 miliosmoles [mOsm]/L). Thermography recording of the ocular surface (natural blinking over a period of 30 seconds) was conducted the next day, and the thermal cooling rate and thermal interblink interval (IBI) were derived.ResultsThermal IBI was significantly shorter in the DED group compared to the non-DED group (P = 0.034). The thermal cooling rate was significantly faster in the DED group (P = 0.047). Thermal IBI significantly correlated with DEQ5 (r = −0.37, P = 0.025) and OSDI (r = −0.37, P = 0.026). The thermal cooling rate significantly correlated with DEQ5 (r = −0.39, P = 0.022) and OSDI (r = −0.36, P = 0.036). The best discrimination was achieved by combining the thermal cooling rate and TMH, with an area under the curve (AUC) = 0.80 (sensitivity = 0.87 and specificity = 0.63).ConclusionsThe thermal IBI and thermal cooling rate were significant predictors of DED, suggesting the utility of ocular thermography for DED screening.Translational RelevanceAutomated ocular thermography may help to assess ocular dryness in a noninvasive, quantifiable, and real-time manner.

ABSTRACT Clinical relevance Facial paralysis (FP) often leads to ocular surfacedisorders due to delayed or incomplete blinking. Background This study aimed to evaluate the ocular surface andmeibomian glands (MG) in patients with unilateral FP. Methods A total of 26 patients with unilateral FP were included.Invasive tear film break-up time (TF-BUT), ocular surface staining score,Schirmer II test, total eyelid score, and MG secretion score were assessed.Non-contact meibography was used to evaluate the percentage of MG loss area,meiboscore, and morphological features (thickening, thinning, tortuosity,fluffy areas, shortening, ghost areas) of the MGs. Results TF-BUT and Schirmer II test values were significantlylower in the FP group (p < 0.001 and p = 0.001, respectively). The Oxfordstaining score, MG expressibility score, and total eyelid score weresignificantly higher in the FP group (p < 0.001, p = 0.003, and p = 0.005,respectively). Meiboscore values were higher in both the upper and lowereyelids in the FP group compared to the control group, with a statisticallysignificant difference only in the lower eyelid (p = 0.270 for upper and p = 0.039 for lower). The presence of MG thickening wasremarkable in the FP group. The House-Brackmann grade was identified as theonly independent factor affecting both upper and lower eyelid meiboscores. Conclusion Facial paralysis impairs ocular surface parameters andincreases lid margin abnormalities. It is associated with higher meiboscoresand deterioration in meibomian gland morphology.

The effects of vitamin d replacement therapy on ocular surface health in children with vitamin d deficiency.

Infectious keratitis is a major cause of corneal blindness, with bacterial keratitis particularly prevalent in tropical, agriculture-dominant regions such as Southern Vietnam. To identify the demographic characteristics, risk factors, clinical features, and antibiotic susceptibility patterns of bacteria isolated from patients with corneal ulceration. A case series was conducted involving patients who presented to the Cornea Department of Ho Chi Minh City Eye Hospital between November 2020 and October 2021. A total of ninety-nine cases of bacterial keratitis were documented. The mean age of the patients was 48.2 ± 15.3years. Most participants were male, and the majority were cultivators (30.3%). Meibomian gland dysfunction was the most frequent predisposing factor (57.6%), followed by ocular trauma (52.5%) and diabetes mellitus (16.2%). The mean duration from symptom onset to presentation was 4.1 ± 3.1days; however, patients with Pseudomonas aeruginosa keratitis presented significantly earlier (2.8 ± 1.6days) than those with other bacterial infections. The most commonly isolated organisms were coagulase-negative Staphylococcus (57.6%) and Pseudomonas aeruginosa (21.2%). Staphylococcus spp. keratitis was significantly associated with peripheral infiltration, shallow stromal involvement, and absence of hypopyon. In contrast, Pseudomonas aeruginosa keratitis was strongly associated with eyelid edema, conjunctival edema, central infiltration, deep stromal involvement, stromal melting, ring infiltrate, retrocorneal plaque, hypopyon > 1mm, and fibrin formation in the anterior chamber. The majority of coagulase-negative Staphylococcus isolates were susceptible to vancomycin (90-100%). Pseudomonas aeruginosa isolates were highly susceptible to tobramycin (100%) and levofloxacin (95.0%), whereas none were susceptible to moxifloxacin. The proportions of multidrug-resistant isolates among coagulase-negative Staphylococcus and Pseudomonas aeruginosa were 68.4% and 85.7%, respectively. Multidrug-resistant strains among coagulase-negative Staphylococcus and Pseudomonas aeruginosa were notably prevalent. Our study provides valuable insights into the clinical and microbiological patterns of bacterial keratitis, which guide antibiotic selection and management.

PurposeThe purpose of this study was to investigate the impact of Helicobacter pylori (H. pylori) infection on ocular surface homeostasis, including dry eye symptoms, ocular microbiota alterations, and related immune responses.MethodsThirty-one H. pylori-positive (Hp_pos) and 30 H.pylori-negative (Hp_neg) subjects underwent dry eye assessments, including the Schirmer I test, noninvasive keratography first and average breakup times (NIKf-BUTs and NIKav-BUTs), tear meniscus height, meibomian gland loss, and the Ocular Surface Disease Index (OSDI). Sterile swabs were used to collect samples from each eye of subjects for 16S rRNA sequencing. Additionally, a murine H.pylori infection model was established to evaluate dry eye phenotypes and immune responses in the lacrimal gland.ResultsCompared with Hp_neg subjects, Hp_pos subjects showed significantly reduced Schirmer I test results, NIKf-BUT, and NIKav-BUT, along with higher OSDI scores (all P < 0.05), whereas tear meniscus height and meibomian gland loss did not differ between the two groups. The ocular surface microbiota of Hp_pos subjects exhibited altered alpha and beta diversity, with 10 enriched genera (dominated by Veillonella and Capnocytophaga), which were characteristically associated with dry eye manifestations. In the murine model, infected mice at 6 weeks post-infection displayed aqueous tear deficiency, corneal epithelial barrier impairment, lacrimal gland infiltration of CD4+ and CD45+ T lymphocytes, and upregulated proinflammatory cytokines (IFN-γ, IL-17A, IL-4, TGF-β, TNFα, IL-6, and IL-1β). However, no significant differences were observed at 2 or 4 weeks post-infection.ConclusionsThe H.pylori infection disrupts tear secretion and ocular surface microbiota, potentially via inducing T lymphocyte infiltration and lacrimal gland inflammation, contributing to dry eye pathogenesis.

This study aimed to unveil the impact of optimal pulse technology (OPT) combined with tobramycin and dexamethasone eye ointment on the ocular surface disease index (OSDI) and related outcomes in patients with blepharokeratoconjunctivitis (BKC). Ninety-six BKC patients treated at our hospital from September 2022 to September 2023 were divided into a control group (n = 48) and an observation group (n = 48) by a random number table. Both groups received fluorometholone and sodium hyaluronate eye drops. The control group additionally applied tobramycin and dexamethasone eye ointment to the lid margin twice daily, while the observation group underwent OPT on this basis. The clinical efficacy and safety, OSDI, conjunctival hyperemia score, lid margin alteration score, meibomian gland yield secretory score (MGYSS), Demodex mite count, and tear break-up time (TBUT) were compared between the two groups before treatment and at 4 and 8 weeks post-treatment. Additionally, the National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) scores were assessed before and after treatment. The total effective rate in the observation group was 100.00% (48/48) at 8 weeks post-treatment, higher than 89.58% (43/48) in the control group (P < 0.05). The OSDI, conjunctival hyperemia score, lid margin alteration scores, MGYSS, and Demodex mite count all decreased in both groups at 4 and 8 weeks post-treatment compared to baseline, with greater improvements in the observation group(P < 0.05). TBUT and NEIVFQ-25 scores increased in both groups at 8 weeks post-treatment compared to baseline, with the observation group achieving better outcomes than the control group (P < 0.05). The addition of OPT to standard therapy for BKC is safe and provides superior short-term efficacy. It can alleviate lid margin inflammation, improve ocular surface symptoms, and enhance visual-related quality of life.

PurposeTo evaluate tear film and ocular surface parameters and estimate the prevalence of dry eye disease (DED) in eyes following corneal transplantation.Patients and MethodsThis cross-sectional study assessed 104 eyes of 81 patients who had undergone penetrating keratoplasty (PK; 81 eyes), deep anterior lamellar keratoplasty (DALK; 9 eyes), or endothelial keratoplasty (EK; 14 eyes) for ≥ 3 months. Comprehensive ocular surface evaluations included the Ocular Surface Disease Index (OSDI), tear osmolarity, tear meniscus height (TMH), fluorescein tear breakup time, Oxford fluorescein staining, eyelid margin morphology, Schirmer I test, meibomian gland expressibility, and meibum quality.ResultsAmong post-PK/DALK eyes, more than 50% demonstrated at least one significant ocular surface abnormality, whereas this was observed in at least 25% of post-EK eyes. Elevated tear osmolarity was detected in approximately 20% of eyes in both groups. Based on TFOS DEWS II criteria, 32% of post-PK/DALK eyes and 57% of post-EK eyes met the diagnostic threshold for DED. Post-PK/DALK eyes with a follow-up time of ≤ 6 months exhibited significantly higher Oxford staining scores compared to those with follow-up > 6 months (P = 0.011). In unilateral PK/DALK cases, operated eyes showed greater ocular surface staining (P < 0.001) and a greater proportion of tear hyperosmolarity (P = 0.001) compared to unoperated fellow eyes.ConclusionDED is common after corneal transplantation. While more pronounced in the early postoperative period, ocular surface epitheliopathy may persist long-term after surgery. These findings underscore the need for proactive long-term ocular surface monitoring and management to optimize surgical outcomes.

Abstract PURPOSE: Conjunctival microvasculature is associated with ocular and systemic diseases. Previous studies have reported increased blood flow velocity (BFV), blood flow rate (BFR), vessel density, and diameter in dry eye disease (DED). This study aimed to compare bulbar conjunctival microvascular morphology and hemodynamics between patients with DED with and without Sjögren’s dry eye (SSDE and NSDE) who had comparable symptoms, and to assess their correlations with Meibomian gland dysfunction (MGD) parameters. MATERIALS AND METHODS: In this prospective study, conjunctival imaging for the left eyes of patients with DED was performed using a previously developed optical system incorporating Attention-UNet-based vessel segmentation and a validated two-step motion-correction pipeline. Tear film lipid layer thickness measurement and meibography were performed using the LipiView® II Ocular Surface Inferometer. Microvascular parameters, including BFV, BFR, and diameter, were quantified. RESULTS: The mean microvessel diameter for the SSDE group (12.985 ± 2.478 μm) was significantly higher than that for NSDE (9.431 ± 3.982 μm) ( P &lt; 0.050). In the NSDE group, diameter correlated positively with BFR ( P &lt; 0.050), and BFR correlated with both upper and lower meiboscores ( P &lt; 0.050). CONCLUSION: These findings reveal distinct conjunctival microvascular signatures in patients with SSDE, and support vessel diameter as a discriminator. The association between hemodynamic changes and MGD parameters in the NSDE group underscores the interplay between MGD and conjunctival microcirculation in NSDE. The differences in microvasculature identified in this study may serve as valuable biomarkers for DED subtype classification and the development of personalized treatment.

PurposeTo compare the corneal epithelial thickness (CET), the density and number of central corneal subbasal nerve plexus (CSNP) between controls and different types of diabetic retinopathy in type 2 diabetics.MethodsThis cross-sectional study included participants who underwent a comprehensive evaluation comprising anterior segment optical coherence tomography, Keratograph 5M, fluorescein tear break-up time, and in vivo confocal corneal microscopy. Based on the Early Treatment Diabetic Retinopathy Study classification, patients with diabetes were categorized into no diabetic retinopathy (NDR) group, non-proliferative diabetic retinopathy (NPDR) group, and proliferative diabetic retinopathy (PDR) group.ResultsA total of 75 eyes were examined— 20 eyes from 20 control subjects and 55 eyes from 55 patients with diabetes (20 NDR, 14 NPDR, 21 PDR). Compared to controls, diabetic eyes exhibited significant increases in corneal thickness (CT) in each region (all P < 0.05), as well as a decrease in CSNP density (15.18 ± 2.60 vs 11.77 ± 3.77, P = 0.040) and number (39.27 ± 6.87 vs 28.67 ± 9.71, P < 0.001). In the PDR group, CET in all areas (except at 6 mm) was significantly thinner (all P < 0.05). Univariate analysis indicated that central CET and CET measured 2 mm from the center were associated with age, CSNP density, and superior meibomian gland dropout. Multivariate analysis identified CSNP density as the only significant factor associated with CET (P < 0.05).ConclusionDiabetic eyes exhibit a reduction in CSNP density and number and an increase in CT. CET is significantly thinner in patients with PDR. Furthermore, CET correlates with CSNP density.