Meibomian Gland Dysfunction Severity Research Articles

Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction.

Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility. Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy. Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = -0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy. Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.

Treatment Practices and Outcomes of Meibomian Gland Dysfunction at a Tertiary Center in Southern India

To describe the current treatment practices for meibomian gland dysfunction (MGD) at a tertiary eye center, together with the subjective outcomes and compliance behaviors of patients. This retrospective cohort study reviewed medical records for MGD severity grading, treatment prescribed, and follow-up schedule. In addition, participants were surveyed to gauge subjective outcomes and treatment adherence. Eight hundred ten patients were diagnosed with "MGD" or "meibomitis" and had a total of 14 different treatment combinations prescribed. In 3.0% of cases, there was no treatment specified. As MGD severity increased, it became more likely that management would be applied and this was also associated with significantly longer treatment durations (P=0.02) and shorter follow-up periods (P<0.001). Posttreatment subjective outcomes and treatment adherence surveys had a response rate of 36.7% and 24.1% respectively. Overall, 53.5% reported sustained improvement, 40.7% no improvement, and 5.7% experienced temporary relief. Although no treatment regimen seemed to be more efficacious than others, patients showed greater adherence when using topical reagents compared with lid hygiene measures (P≤0.002). Clinicians, in this large tertiary eye center, use a wide range of treatment regimens to manage MGD. This suggests the need for development of standard management protocols. Whether alone, or in combination, no MGD treatment significantly improved subjective symptoms, a result that may be influenced by compliance behaviors. Use of topical reagents (eye drops or ointment) seemed to be associated with the best compliance. Future focus on more effective MGD treatments is needed to improve practical outcomes.

Association of the severity of meibomian gland dysfunction with dyslipidemia in Indian population.

Purpose:To correlate the severity of meibomian gland dysfunction (MGD) with the serum lipoprotein levels.Methods:The study was conducted as a prospective observational study over a period of 18 months. Ninety patients diagnosed with MGD were enrolled after they gave their informed consent according to the inclusion–exclusion criteria. Meibomian gland status was evaluated by meibum quality, expressibility, and numerical scoring. Lipid profile was done from an overnight fasting blood sample and evaluated for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs).Results:Patients with higher stages of MGD more often had serum TGs >150 mg/dL, total cholesterol >200 mg/dL, an LDL >130 mg/dL, and serum HDL >40 mg/dL, and there exists an association between increasing stage of MGD, and age, female sex, and increasing values of all the lipid profile components.Conclusion:A very strong association exists between increasing age and increasing severity of stage of MGD. A positive association exists between female sex and increasing severity of stage of MGD. A positive association exists between increasing severity of MGD and increasing levels of all the components of lipid profiles, namely LDL, HDL, total cholesterol, and triglycerides.

Eyelid Changes Related to Meibomian Gland Dysfunction in Early Middle-Aged Patients Using Topical Glaucoma Medications.

To investigate the relationship between topical glaucoma medications and meibomian gland dysfunction (MGD) in early middle-aged patients with glaucoma. In this cross-sectional study, 50 patients with glaucoma younger than 50 years who had used topical glaucoma medications for more than 6 months and 40 normal controls of similar age were included. Patients in each group were graded for MGD (0-4) using slit-lamp microscopy. Tear film breakup time (BUT), ocular surface staining, and Marx line scores were also evaluated. Differences between both groups were analyzed statistically. The prevalence of MGD was 82% in the group using topical glaucoma medications and 52.5% in the control group. The average period of topical glaucoma medication use was 27.4 months. There were significant differences in the breakup time and Marx line score according to the presence of MGD. Although the duration of topical glaucoma medication use and the severity of MGD did not show a significant correlation, the degree of MGD and the Marx line score were significantly correlated. Glaucoma eye drops may be one factor affecting the eyelid changes associated with MGD. The Marx line score may be used as an index to evaluate MGD in patients with glaucoma.

Comparison of treatment effect across varying severities of meibomian gland dropout

Better understanding of the pathophysiology of meibomian gland dysfunction (MGD) has provided the opportunity to develop treatments which could be tailored for specific presentations of MGD. This study sought to directly compare treatment effectiveness for three current therapies across differing levels of MG dropout. Subjects (n=81), grouped by infrared meibography dropout proportions, into either no (control), mild, or pronounced MG dropout, were randomised to receive treatment with a latent heat device (n=25), liposomal spray (n=28), or heated warm compress (n=28). A battery of tear film measures was performed, pre- and post-application of treatment, and compared by treatment type and MG severity. Symptoms correlated with MG dropout proportions (r=0.618, p<0.001). Following treatment, non-invasive tear breakup time improved (p=0.010), independent of treatment type (p=0.131). The improvement was significant only in the pronounced MGD group (+4.32 ±1.15s, p=0.008), however, following treatment, the mild group was no longer distinct from the control group (p=0.843). Lipid layer grade (LLG) also improved following treatment (p<0.009), but again was not specific to treatment type (p=0.349). All three severity groups showed an improvement in LLG, with 49.3% of participants showing an improvement of at least one grade, and none showing decreased LLG. Increased LLG across all three treatment groups suggests that all methods increase meibum outflow to the tear film, resulting in a thicker lipid layer after treatment. These results suggest that all three treatments are effective in improving tear film quality, independent of MGD severity based either on symptoms or based on gland dropout.

Meibomian Gland Dysfunction Correlates to the Tear Film Instability and Ocular Discomfort in Patients with Pterygium

Pterygium is a very common disease in an eye clinic characterized by a benign proliferation of local conjunctiva that often crosses the limber of cornea and extends into corneal surface. Variety of studies has showed that pterygium is able to result in ocular discomfort and the change of ocular surface environment, such as dry eye. However, the link between abnormal tear film function and pterygium is controversial. Meibomian gland dysfunction (MGD) is a common cause of dry eye and ocular discomfort but is often neglected, which may be the missing link between dry eye and pterygium. In this study, our data firstly revealed increased abnormality of meibomian gland structure and function in pterygium patients, representing with increased abnormality of MGD parameters such as meibum expression (P < 0.001) and meibomian gland loss (P < 0.001). Besides, the scores of MGD severity in patients with progressive pterygium were higher than those in patients with resting pterygium. The correlation between MGD parameters and ocular discomfort as well as dry eye indexes is also established. These findings suggest that MGD correlates to the tear film instability and ocular discomfort in patients with pterygium.

Morphological and Functional Evaluation of Meibomian Gland Dysfunction in Rosacea Patients

ABSTRACTPurpose: Skin rosacea is a chronic inflammatory disease affecting up to 10% of the population in some European countries. Although considered a skin disease, acne rosacea may involve the eyes, causing eyelid and ocular surface inflammation. This study investigated the relationship between skin rosacea and various signs of ocular involvement and evaluated severity of meibomian gland dysfunction in rosacea patients.Methods: The ocular surface and meibomian gland parameters were evaluated in 41 patients with diagnosed skin rosacea and 44 age-matched healthy controls. We analyzed meibomian gland function (meibum quality and meibum expressibility) and morphology (meibography) and lid margin alterations. We correlated our findings with self-reported ocular symptoms and tear film abnormalities (tear film breakup time, Schirmer test).Results: The prevalence of ocular erythema and lid margin alterations was significantly higher in rosacea patients compared with controls. We found that rosacea is accompanied with significant loss of meibomian gland tissue defined as reduced meibomian gland area and decreased meibomian gland density. A positive correlation between margin abnormality score and the extent of meibomian gland loss in rosacea group was observed (rs = +0.30, p = 0.005), suggesting that ocular rosacea is accompanied by meibomian gland dropout.Conclusion: Skin rosacea is associated with ocular erythema and lid margin abnormalities. Our results suggest that ocular signs of rosacea may influence meibomian gland morphology, causing meibomian gland loss.

Associations Between the Grade of Meibomian Gland Dysfunction and Dyslipidemia

To examine the relationship between dyslipidemia and the severity of meibomian gland dysfunction (MGD). A prospective cohort study of 132 subjects with and 104 without MGD were recruited. A correlation between serum fasting lipids and MGD severity was performed. Mean age for all candidates was 49.4 years; and 57% were women. In all, 42.9% had no MGD, 14.8% had grade 1 MGD, 17.4% had grade 2 MGD, and 23.7% had grade 3 MGD. High cholesterol was found in 37.1% of grade 1 MGD, 43.9% of grade 2 MGD, and 50% of grade 3 MGD. High triglyceride was found in 5.7% of grade 1, 14.6% of grade 2, and 39.3% of grade 3 patients. High low-density lipoprotein was found in 17.1% of grade 1, 29.3% of grade 2, and 35.7% of grade 3 patients. The mean age of the control group was 41.2 years; and 55.4% were women. High cholesterol was found in 42.3%, triglyceride in 7.7%, low-density lipoprotein in 23.1%, low high-density lipoprotein in 3.8%, and high high-density lipoprotein in 3.8%. Although the presence of MGD does not have any correlation with dyslipidemia, the prevalence of high triglyceride and low-density lipoprotein levels increases with the increasing severity of MGD. This might highlight the significance of monitoring fasting serum lipids due to its association with the potential correlation with the progression of MGD.