Meibum Expressibility Research Articles

Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study.

PurposeTo compare the safety and efficacy of intense pulsed light (IPL) followed by meibomian gland expression (MGX), against monotherapy of MGX.MethodsPatients with moderate to severe meibomian gland dysfunction (MGD) were 1:1 randomized to 4 sessions of intense pulse light + MGX at 2-week intervals, or 4 sessions of Sham + MGX at 2-week intervals. Both patients and examiners were blinded to the allocation. Outcome measures, evaluated at the baseline (BL) and at a follow-up (FU) conducted 4 weeks after the last IPL session, included fluorescein tear breakup time (TBUT) as the primary outcome measure, OSDI (Ocular Surface Disease Index) questionnaire, Eye Dryness Score (EDS, a visual analog scale (VAS)-based questionnaire), Meibomian gland score (MGS, a score of meibum expressibility and quality in 15 glands on the lower eyelid), daily use of artificial tears, and daily use of warm compresses. In addition, during each treatment session, the number of expressible glands was counted in both eyelids, the predominant quality of meibum was estimated in both eyelids, and the level of pain/discomfort due to MGX and IPL was recorded.ResultsTBUT increased from 3.8±0.2 (μ±standard error of mean (SEM)) to 4.5±0.3 seconds in the control arm, and from 4.0±0.2 to 6.0±0.3 in the study arm. The difference between arms was statistically significant (P < .01). Other signs/symptoms which improved in both arms but were greater in the study arm included MGS (P < .001), EDS (P < .01), the number of expressible glands in the lower eyelids (P < .0001) and upper eyelid (P < .0001), the predominant meibum quality in the lower eyelid (P < .0001) and upper eyelid (P < .0001), and the level of pain due to MGX (P < .0001). Outcome measures which improved in both arms with no significant differences between the two were OSDI (P = .9984), and the daily use of artificial tears (P = .8216). Meibography, daily use of warm compresses, and severity of skin rosacea did not show statistically significant changes in either arm. No serious adverse events were observed. There was a slight tendency for more adverse events in the control group (P = 0.06).ConclusionsThe results of this study suggest that, in patients with moderate to severe symptoms, combination therapy of intense pulse light (IPL) and meibomian gland expression (MGX) could be a safe and useful approach for improving signs of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Future studies are needed to elucidate if and how such improvements can be generalized to different severity levels of MGD.

Changes in Dry Eye Status after Steroid Pulse and Orbital Radiation Therapies in Active Thyroid Eye Disease.

This prospective, observational study examined changes in dry eye status after steroid pulse and orbital radiation therapies in 16 patients (32 eyes) with active thyroid eye disease (TED). TED status was evaluated through clinical activity score (CAS), margin reflex distance (MRD)-1 and 2, presence or absence of Graefe’s sign/lid lag, and Hertel exophthalmometric value. Dry eye status was quantified through presence or absence of superior limbic keratoconjunctivitis, corneal fluorescein staining (AD score), tear break-up time, Schirmer test I results, tear meniscus height, and dry eye-related quality of life score. Meibomian gland dysfunction (MGD) was evaluated through Marx line score, eyelid abnormalities (MGD score), meibum expression score, and meibomian gland loss score. Those items were measured before and 6 months after treatment, and the results were statistically compared. Consequently, CAS significantly improved, and MRD-1 significantly decreased after treatment (p < 0.050). Although a part of MGD status improved (p < 0.050), all items regarding dry eye status did not change significantly after treatment (p > 0.050). Steroid pulse and orbital radiation therapies did not largely alter most items regarding dry eye and MGD status.

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.

Thermal Pulsation with or without Dexamethasone Intracanalicular Insert for Meibomian Gland Dysfunction: A Prospective, Masked Trial

SignificanceMeibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy.PurposeTo compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD.MethodsThis was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12.ResultsNineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects.ConclusionThis study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.

Meibomian Gland Density: An Effective Evaluation Index of Meibomian Gland Dysfunction Based on Deep Learning and Transfer Learning.

We aimed to establish an artificial intelligence (AI) system based on deep learning and transfer learning for meibomian gland (MG) segmentation and evaluate the efficacy of MG density in the diagnosis of MG dysfunction (MGD). First, 85 eyes of 85 subjects were enrolled for AI system-based evaluation effectiveness testing. Then, from 2420 randomly selected subjects, 4006 meibography images (1620 upper eyelids and 2386 lower eyelids) graded by three experts according to the meiboscore were analyzed for MG density using the AI system. The updated AI system achieved 92% accuracy (intersection over union, IoU) and 100% repeatability in MG segmentation after 4 h of training. The processing time for each meibography was 100 ms. We discovered a significant and linear correlation between MG density and ocular surface disease index questionnaire (OSDI), tear break-up time (TBUT), lid margin score, meiboscore, and meibum expressibility score (all p < 0.05). The area under the curve (AUC) was 0.900 for MG density in the total eyelids. The sensitivity and specificity were 88% and 81%, respectively, at a cutoff value of 0.275. MG density is an effective index for MGD, particularly supported by the AI system, which could replace the meiboscore, significantly improve the accuracy of meibography analysis, reduce the analysis time and doctors’ workload, and improve the diagnostic efficiency.

Global improvement in meibomian glands after chalazion surgery demonstrated by meibography.

To evaluate the use of meibography as an objective measure of the effects of incision & curettage (I&C) chalazion surgery on meibomian gland loss and morphology as well as dry eye syndrome. This prospective, interventional clinical study included adult patients with a primary chalazion which persisted despite conservative treatment. All patients underwent I&C surgery. The following parameters were compared both preoperatively and 21days postoperatively: meibography, tear breakup time (TBUT), Schirmer test, meibum expression, tear meniscus height, meibomian gland dysfunction (MGD) grading, and the Ocular Surface Disease Index (OSDI). Thirty eyelids were enrolled in the study. The mean age ± SD was 40.56 ± 13.94years. Meibography demonstrated a significant decrease in meibomian gland loss (P = 0.00) and improvement in morphology. The most common meibomian gland pathology preoperatively noted was morphological signs of atrophy that included fluffy areas and tortuous glands. Both of these findings improved postoperatively (P = 0.04 and P = 0.02, respectively). There were a significant change in MGD grading and a significant decrease in meibum expression score postoperatively (P = 0.00). TBUT and tear meniscus height also improved significantly (P = 0.00 and P = 0.003, respectively). The OSDI score improved significantly as well (P = 0.00). While incision and drainage surgery is a time-honored, standard treatment for chalazion, meibography now demonstrates a global improvement in the meibomian glands, not just the ones involved with the chalazion. In addition to the improvements in the clinical and dry eye syndrome parameters improvements, meibography findings demonstrate that early I&C surgery restores the meibomian glands architecture significantly.

Compliance with Lid Hygiene in Patients with Meibomian Gland Dysfunction.

PurposeTo evaluate the level and predictor of compliance with lid hygiene of the patients with meibomian gland dysfunction (MGD) by a specially designed and validated questionnaire.Patients and MethodsA cross-sectional, descriptive study was conducted among patients with symptomatic meibomian gland dysfunction visiting at Ramathibodi Hospital from April 2019 to December 2020. Dry eye symptom, fluorescein tear breakup time (TBUT), ocular surface staining, lid morphology, meibum quality, and meibum expressibility were evaluated. All patients were instructed to perform lid hygiene two times daily. Eight weeks after receiving the instruction, the patients were asked to complete a newly developed seven-item questionnaire to assess compliance. The associated factors limiting treatment adherence were evaluated. Proper statistical analyses were used to determine the relationships between compliance and non-compliance and a group of relevant baseline variables. P < 0.05 was considered to be statistically significant.ResultsA total of 77 patients were recruited into the study. Sixty-three patients (81.8%) were female. The mean age was 66.71 ± 8.17 years old (42–87 years). Good compliance with lid hygiene was reported by 42 patients (54.6%). Patient demographic factors or the number of concurrent systemic or ophthalmic drugs were not significantly different between the compliance and non-compliance groups. Some clinical signs, including the higher scores of meibomian gland expressibility and moderate to severe ocular surface staining, were significantly positively associated with lid hygiene compliance (χ2 = 10.13, P = 0.001 and χ2 = 10.48, P = 0.001, respectively). A lack of time was the most notable reason for non-compliance.ConclusionApproximately half of the patients with symptomatic MGD had good compliance with lid hygiene by the specific questionnaire. Appropriate patient education and optimization methods of lid hygiene may promote patient compliance.

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.

Comparison Between Heated Eye Mask and Intense Pulsed Light Treatment for Contact Lens-Related Dry Eye.

Background: Contact lens-related dry eye (CLDE) is common in contact lens (CL) wearers and can lead to ocular pain, decreased visual quality, and reduced quality of life. Objective: The purpose of this prospective, randomized, examiner masked study was to compare the effectiveness of intense pulsed light (IPL) and heated eye mask (HEM) for relieving CLDE. Methods: The final analysis included 60 patients (30 in the IPL group and 30 in the HEM group) who were using CL and had been suffering contact lens discomfort for more than a year. The IPL treatment group had two IPL treatments spaced 3 weeks apart, whereas the HEM group received HEM daily for 6 weeks (42 days). Non-invasive tear break-up time (NITBUT), tear-film lipid layer (TFLL), conjunctival fluorescein staining, meibum gland quality and expression, conjunctival redness score, ocular surface disease index (OSDI), best-corrected visual acuity, endothelial cell count, and intraocular pressure were assessed at baseline: first visit (V1), second visit (V2), and third visit (V3). Results: The mean age of the IPL group was 28.6 ± 4.3 years (16 females, 53%) and that of the HEM group was 28.6 ± 4.2 years (16 females, 53%). Mean NITBUT for the IPL group at V2 was 5.53 ± 0.77 sec (p < 0.001) and at V3 was 7.72 ± 0.88 sec (p < 0.001); the IPL group demonstrated a clinically and statistically significant improvement in mean NITBUT. In addition, the HEM group showed a clinically and statistically significant improvement in mean NITBUT at V3 (5.86 ± 0.76 sec, p < 0.001). At V3, the C-OSDI, TFLL score, and meibum gland quality and expressibility all increased considerably (p < 0.05) in both groups. Conclusions: Our results imply that IPL or HEM treatment of CLDE can be safely used to relieve symptoms of CLDE. In addition, IPL treatment is more effective in improving the general stability of the tear-film and decreasing the need for artificial tears in CLDE.

Dry eye disease and meibomian gland dysfunction among a clinical sample of type 2 diabetes patients in Ghana.

To evaluate dry eye disease and meibomian gland dysfunction among type 2 diabetes patients. A hospital-based cross-sectional study was conducted. Parameters assessed included meibum expressibility and quality, Schirmer test 1, tear breakup time (TBUT), ocular surface staining, blink rates and Ocular Surface Disease Index (OSDI) scores. Dry eye was diagnosed based on a combination of subjective symptoms, tear function and ocular surface staining. Prevalence of DED and MGD were 72.3% and 55.3% respectively. Symptomatic dry eye (OSDI scores) was significantly associated with duration of diabetes (rs = 0.11, P = 0.028) and the presence of conjunctival disorders (OR = 2.09, P = 0.002). MGD was a risk factor for DED (OR = 1.99, P = 0.008); ocular surface damage, the presence of eye lid lesions, abnormal Schirmer test and reduced TBUT were significantly associated with MGD, the strongest predictor being ocular surface damage (OR = 3.21, P = 0.001). OSDI scores had no association with the presence of corneal lesions possibly due to reduced corneal sensitivity. DED and MGD were prevalent among the patients and therefore there is the need for dry eye assessment as a routine clinical management protocol for patients with type 2 diabetes.

Demodex folliculorum Infestation in Meibomian Gland Dysfunction Related Dry Eye Patients.

ObjectiveTo report the influence of Demodex folliculorum (D. folliculorum) infestation in patients with meibomian gland dysfunction (MGD) related dry eye and the associations of the infestation with MGD related dry eye.MethodsEyelashes (three from the upper eyelid and three from the lower eyelid) from 119 eyes of 119 patients diagnosed with MGD related dry eye were examined under a light microscope. There were 68 eyes of 68 patients with MGD related dry eye and D. folliculorum infestation (Demodex positive group) and 51 eyes of 51 patients without infestation (Demodex negative group). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and underwent tests for dry eye and MGD. The tests included fluorescein tear breakup time (TBUT), corneal fluorescein staining, Schirmer I test (SIT), lid margin abnormalities, meibum expression assessment, and meibomian gland dropout.ResultsThe scores for OSDI, corneal fluorescein staining, lid margin abnormalities, meibum expression, and meibomian gland dropout were significantly higher (all P < 0.05), while TBUT was significantly shorter in the Demodex positive group compared to the Demodex negative group (P = 0.020). The SIT values did not significantly differ between groups. Chalazion was significantly more prevalent in the Demodex positive group. The number of D. folliculorum was positively correlated with all three MGD parameters (P ≤ 0.035), OSDI; corneal fluorescein scores, and it was inversely correlated with BUT. The correlation for SIT was R2 = 0.075 (P = 0.064).ConclusionDemodex folliculorum infestation is possibly one of the key contributors in the pathogenesis of MGD related dry eye, and a higher prevalence of chalazion was found in D. folliculorum infected patients. The possible causal role of D. folliculorum infestation needs to be further studied.

Assessment of Meibomian Gland (MD) Impairment Among Seasonal Allergic Conjunctivitis (SAC) Patients.

BackgroundAllergic conjunctivitis, one of the frequently occurring ocular surface diseases, can cause mucus discharge, itchy sensation, conjunctival hyperemia, and papillary formation. Seasonal allergic conjunctivitis (SAC) is associated with xerophthalmia and instability of tear film. Meibomian gland (MG) can secrete lipids to avoid xerophthalmia. However, there have been few reports on MG morphological alterations of SAC patients. This study aimed to examine the morphological alterations of MG among SAC patients.Material/MethodsOur study included 89 eyes from 89 patients with SAC and 112 eyes of healthy volunteers. The symptoms were assessed by ocular surface disease index (OSDI) questionnaire. Then, the tests shown below were carried out, including tear evaporation rate from the ocular surface (TEROS), slit-lamp examination, break-up time (BUT) of tear film, Schirmer test I, vital staining, meibography, and meibum expression grading. MG was examined with laser scanning confocal microscopy (LSCM).ResultsRelative to the control group, the OSDI was significantly higher in the SAC group. TEROS values, BUT, vital staining, MG expression, MG distortion rates, and MG dropout grades were significantly worse in the SAC group compared with the control group. As suggested by LSCM, SAC patients had markedly worse averages of parameters compared with controls.ConclusionsThe patients with SAC have more significant morphological and cytological changes in the MG. The Keratograph 5M system and LSCM are effective methods for evaluating MG status and ocular surface diseases.

Assessment of Eyelid Pressure Using a Novel Pressure Measurement Device in Patients With Moderate-to-Severe Dry Eye Disease.

ObjectiveTo assess a novel eyelid pressure measurement device and study the relationship between eyelid pressure and ocular surface parameters of moderate-to-severe dry eye disease (DED).MethodsThe present study included 70 eyes of 35 moderate-to-severe DED patients. All subjects were subjected to the following examinations for DED assessment: Ocular Surface Disease Index (OSDI) questionnaire, tear meniscus height (TMH), lipid layer thickness (LLT), number of partial blink (PB), total blink (TB) and partial blink rate (PBR), fluorescein tear breakup time (FBUT), corneal fluorescein staining (CFS), lid margin abnormality, meibum expression assessment (meibum score), meibomian gland dropout (MGd) and Schirmer I test. Pressure of the upper eyelid was measured thrice with the novel pressure measurement device. Repeatability of the device was evaluated by intraclass correlation coefficient (ICC). Safety of the device was evaluated by observing ocular adverse reactions of each subject prior to measurement, at day 1 and day 7 following measurement. Correlations between eyelid pressure and ocular surface parameters of moderate-to-severe DED were analyzed by using Pearson correlation coefficient and Kendall's tau-b correlation coefficient.ResultsICC of the measurement results in our study was 0.86. There was no abnormality presenting in all subjects recorded prior to measurement, 1 and 7 days following measurement. The eyelid pressure was significantly correlated with PBR (r = 0.286, P = 0.016), FBUT (r = −0.331, P = 0.005), CFS (r = 0.528, P = 0.000), lid margin abnormality (r = 0.408, P = 0.011) and MGd (r = 0.226, P = 0.016) in moderate-to-severe DED patients, but not significantly correlated with OSDI score (r = 0.016, P = 0.912), TMH (r = −0.002, P = 0.988), meibum score (r = −0.196, P = 0.317), LLT (r = 0.114, P = 0.346), PB (r = 0.116, P = 0.338), TB (r = 0.074, P = 0.544), meibum score (r = −0.196, P = 0.317) and Schirmer I test (r = 0.028, P = 0.821).ConclusionThe novel pressure measurement device exhibited good repeatability and safety in measuring eyelid pressure. Significant correlations were noted between the eyelid pressure and PBR, FBUT, CFS, lid margin abnormality and MGd in moderate-to-severe DED. The measurement of eyelid pressure combined with ocular surface parameters may be valuable for the assessment of DED.

Upper Eyelid Meibomian Gland Dysfunction is a Risk Factor for Dry Eye Symptoms Following Cataract Surgery in the Early Phase.

PurposeTo evaluate perioperative dry eye (DE) syndrome and meibomian gland (MG) dysfunction parameters associated with cataract surgery-induced DE symptoms.Patients and MethodsThis retrospective, single-centered, observational study included 82 eyes of 43 patients without previous subjective DE symptoms, treatment, ocular comorbidities, and previous use of ophthalmic treatment, except for anti-allergic eye drops, who underwent uncomplicated cataract surgery. MG dropout, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, ocular surface disease index, non-invasive tear break-up time, tear meniscus height, and Schirmer test score were measured at baseline and 1 month postoperatively. Multivariable logistic regression with generalized estimating equation models was used to determine the risk factors for cataract surgery-induced DE symptoms.ResultsTwenty-one patients had subjective DE symptoms 1 month following the cataract surgery. Preoperative and postoperative parameters, preoperative upper eyelid MG loss, and female sex (odds ratio [OR] 6.72, P = 0.012; OR 4.20, P = 0.037, respectively) were identified as risk factors for cataract surgery-induced DE symptoms.ConclusionOcular parameters, including upper eyelid MG findings at baseline, were considered important in predicting persistent DE symptoms following cataract surgery.

Evaluation of Meibomian Gland Function after Therapy of Eyelid Tumors at Palpebral Margin with Super Pulse CO2 Laser.

Purpose To investigate the effect on meibomian gland function of super pulse carbon dioxide (CO2) laser excision in the treatment of eyelid tumors at palpebral margin. Methods 36 patients with 36 eyelid tumor size ≤ 1 cm and within 1 mm to palpebral margin were recruited in this study. Of which, 16 cases with tumors in the upper eyelid and 20 cases in the lower eyelid were involved. The eyelid tumors of all the patients were treated by super pulse CO2 laser with its power density varied between 0.6 and 21.1 W/mm2 and in repeat mode. The laser spot size ranged from 120 to 200 μm. Ocular surface parameters including tear film break-up time (BUT) and meibograde, meibum expressibility, and meibum quality were evaluated at pretherapy, 1 week, 1 month, and 3 months posttherapy in all 36 patients. Result All the patients were satisfied with the therapy. No infective complications and recurrence occurred in any of the 36 patients at the following period. The eyelid wound recovered well with nearly normal appearing after 2 to 3 weeks. The morphology of limbi palpebralis, BUT, meibograde, meibum expressibility, and meibum quality of all the 36 patients showed no significant difference before and after the therapy. Conclusions Super pulse CO2 laser had no effect on meibomian gland function and morphology in the excision of tumors at palpebral margins, which was an efficacy and well-tolerated therapy with lower complications and recurrence.

Prevalence and Association of Meibomian Gland Dysfunction with Dry Eye Severity from a Tertiary Care Rural Hospital in Central Gujarat: A Cross-sectional Study

Introduction: Meibomian glands are holocrine meibum secreting glands driving out the oil from the orifice. It forms the outermost lipid layer of the tear film which prevents overflow of tears because of its hydrophobic properties and reduces their evaporation. The deficiency of oily layer of the tear film leads to evaporative dry eyes and ocular surface diseases. As Meibomian Gland Dysfunction (MGD) is one of the major causes of evaporative dry eye, with the help of this study, prevalence and association of MGD and dry eye can be evaluated and treated. Aim: To find out the prevalence and association of MGD and dry eye as well as asymptomatic individuals having MGD and dry eye in 30-80 years age group in the region of central Gujarat, Western India. Materials and Methods: This cross-sectional study was conducted in the Out Patient Department (OPD) of a Rural Tertiary care hospital in central Gujarat, India between February 2020- February 2021, after taking approval from Institutional Ethics Committee. Study included 389 subjects representing rural population of Anand, Gujarat, India. Subjects were asked for symptoms of dry eye according to Ocular Surface Disease Index (OSDI) questionnaire and severity of symptoms was assessed. Comprehensive ophthalmic examination including Best Corrected Visual Acuity (BCVA), Schirmer’s test, slit lamp examination including conjunctival and corneal surface staining, Tear Film Break Up Time (TBUT), evaluation of meibomian gland orifices, lid margin anatomy, meibum expressibility, quality of meibum, meibomian gland dropouts was done. On the basis of these parameters, diagnosis and grading of MGD and dry eye was done. Subgroups were made according to age, gender, comorbidities (diabetes mellitus, hypertension, thyroid disease), cases of any refractive eye surgery, pseudophakic eyes, use of systemic drugs, hormonal pills, topical antiglaucoma drugs and use of contact lens. Data analysis was done by descriptive statistics (using Stata software 14.2 version). Analysis of Variance (ANOVA) were used to assess the association and Pearson test was applied to assess the correlation of MGD scores and dry eye severity with age. Results: Overall prevalence of MGD and dry eye were 97.4 % and 88.82% respectively. Out of all, 219 (56.3%) participants were asymptomatic. Age was significantly correlated with MGD and dry eye severity. Higher MGD scores were found with increase with dry eye severity. Highest MGD scores were observed when the tear break up time was &lt;5 seconds. Conclusion: The prevalence of MGD and dry eye was high in the region of central Gujarat, India. MGD leads to deficiency of oily layer of the tear film leading to evaporative dry eyes and ocular surface diseases.

Efficacy of Intense Pulsed Light Treatment in Patients with Sjögren’s Syndrome Associated with Meibomian Gland Dysfunction

Purpose: To investigate the efficacy of intense pulsed light (IPL) treatment in patients with meibomian gland dysfunction (MGD) associated with Sjögren’s syndrome.Methods: This study included 43 patients with MGD and Sjögren’s syndrome. Patients received either IPL with meibomian gland expression (IPL/MGX) (n = 22) or MGX only (n = 21). Treatments were administered three times at a 3-week interval. Patients were followed up 6 weeks after the end of the treatment. Ocular Surface Disease Index (OSDI), tear film breakup time with fluorescein dye (FBUT), non-invasive tear breakup time, tear meniscus height (TMH), Schirmer test, SICCA ocular surface staining score, meibum quality score (MQS), and meibum expression score (MES) were evaluated at each visit. Meibomian gland dropouts (meiboscore) and tear film lipid layer grade were measured using keratography.Results: OSDI, FBUT, corneal surface staining score, MQS, meiboscore, and tear film lipid layer grade improved after IPL/MGX treatment (p &lt; 0.05). In both treatment groups, MES significantly improved (p &lt; 0.01 and p &lt; 0.05 for IPL/MGX and MGX groups, respectively). The Schirmer test score, conjunctival surface staining score, and TMH after treatment were not significantly different between the groups. After treatment, the IPL/MGX group had significantly lower OSDI, FBUT, corneal staining score, MQS, and MES, but higher FBUT, compared with the MGX group (p &lt; 0.05).Conclusions: IPL treatment effectively improved tear film, ocular surface parameters, meibomian gland function, and lipid layer grade in patients with Sjögren’s syndrome and MGD.

Changes of Dry Eye Related Markers and Tear Inflammatory Cytokines After Upper Blepharoplasty.

Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty.Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined.Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p <0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively).Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.

Measurement of the Lid Margin Thickness in Meibomian Gland Dysfunction with Vernier Micrometer.

IntroductionTo investigate the lid margin thickness (LMT) from the posterior lash line to the mucocutaneous junction at the middle position in adults with and without meibomian gland dysfunction (MGD) by vernier micrometer (VM).MethodsThis is a cross-sectional, observational study. A hundred eyes from 100 volunteers aged 20 to 79, including 56 normal participants and 44 participants with MGD, were recruited. Measurements of the LMT by VM were performed by the same person.ResultsThe mean age of 56 normal subjects (24 males and 32 females) and 44 MGD subjects (16 males and 28 females) was 40.0 ± 13.2 years and 42.7 ± 17.1 years, respectively. There was a significant difference in the upper LMT between normal and MGD subjects (1.36 ± 0.25 vs. 1.60 ± 0.27 mm, P < 0.001), but not in the lower LMT (1.0 ± 0.23 vs. 1.10 ± 0.28 mm, P = 0.07). In both normal and MGD subjects, the upper or lower LMT was significantly positively correlated with age (P < 0.05), and the upper LMT was greater than the lower LMT (P < 0.001). In addition, the lower LMT in MGD subjects was significantly positively correlated with meibum expressibility (rs = 0.35, P = 0.02).ConclusionsThe LMT was closely related to age and could be an important indicator for detecting MGD. Furthermore, we found that the upper LMT was greater than the lower LMT, and the lower LMT in MGD subjects seemed to be related to meibum expressibility.

The Ocular Surface Characteristics in Prostate Cancer Patients Treated with Androgen Deprivation Therapy.

BackgroundTo investigate the association of long-term androgen deprivation therapy (ADT) with ocular surface characteristics in prostate cancer patients. Methods A total of 30 male prostate cancer patients who received ADT were selected. All candidates were scored using the Ocular Surface Disease Index (OSDI) and subsequently divided into two groups containing 9 symptomatic patients (scores >12) and 21 asymptomatic patients (scores ≤ 12). Another 20 healthy age-matched males were selected as the control group. Each candidate was assessed with respect to eyelid margin abnormality, tear film break-up time (NI-BUT), tear meniscus height (TMH), meiboscore, meibum expressibility, and demodex infection. Results The NI-BUT in the ADT group was significantly shorter than that in the control group. The scores for OSDI, eyelid margin abnormality, meibum expressibility, and meiboscores were significantly higher in the ADT group (P < 0.05). Moreover, the NI-BUT in the symptomatic ADT group was significantly shorter than that in the asymptomatic ADT group (P < 0.05). The meiboscores and meibum expressibility score in the symptomatic ADT group were significantly higher than those in the asymptomatic ADT group (P < 0.05). The presence of demodex in the symptomatic ADT group was also higher than that in the asymptomatic ADT group (P < 0.05).The length of time that patients had been taking ADT was positively correlated with meiboscores and negatively correlated with NI-BUT. Conclusion Androgen levels were associated with significant changes in relative meibomian gland function. Subjective symptoms, such as dryness and foreign body sensation, were more obvious in prostate cancer patients receiving ADT, which may be caused by MGD and demodex infection. It's recommended that more attention be paid to the ocular surface in prostate cancer patients taking ADT by performing examination of NI-BUT and meibomian gland morphology and function with a view to providing more comprehensive prevention and treatment protocols.