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Am J Ophthalmol. 2019 Apr;200:16-25. doi: 10.1016/j.ajo.2018.12.006. Epub 2018 Dec 20.

Meibomian Gland Morphology Is a Sensitive Early Indicator of Meibomian Gland Dysfunction.

Author information

1
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; The Norwegian Dry Eye Clinic, Oslo, Norway. Electronic address: m_yasin_93@hotmail.com.
2
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; The Norwegian Dry Eye Clinic, Oslo, Norway.
3
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
4
Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway; The Norwegian Dry Eye Clinic, Oslo, Norway; Department of Ophthalmology, Arendal Hospital, Arendal, Norway; Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway, Kongsberg, Norway.
5
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
6
The Norwegian Dry Eye Clinic, Oslo, Norway.
7
Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
8
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
9
Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway; Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway, Kongsberg, Norway; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.

Abstract

PURPOSE:

To investigate the relationship between meibomian gland (MG) morphology and clinical dry eye tests in patients with meibomian gland dysfunction (MGD).

DESIGN:

Cross-sectional study.

SUBJECTS:

Total 538 MGD patients and 21 healthy controls.

METHODS:

MG loss on meibography images of upper (UL) and lower lids (LL) was graded on a scale of 0 (lowest degree of MG loss) to 3. MG length, thickness, and interglandular space in the UL were measured. Clinical tests included meibum expression and quality, tear film break-up time, ocular staining, osmolarity, Schirmer I, blink interval timing, and Ocular Surface Disease Index (OSDI) questionnaire.

RESULTS:

Mean UL and LL meibogrades were significantly higher in MGD patients compared to controls (P < .001 for UL and LL). The sensitivity and specificity of the meibograde as a diagnostic parameter for MGD was 96.7% and 85%, respectively. Schirmer I was significantly increased in MGD patients with meibograde 1 compared to patients with meibograde 0, 2, and 3 in the UL (P < .05). MG thickness increased with higher meibograde (P < .001). MG morphology correlated significantly but weakly with several clinical parameters (P < .05). OSDI did not correlate with any MG morphologic parameter.

CONCLUSIONS:

Grading of MG loss using meibograde effectively diagnoses MGD. Compensatory mechanisms such as increased aqueous tear production and dilation of MGs make early detection of MGD difficult by standard clinical measures of dry eye, whereas morphologic analysis of MGs reveals an early stage of MGD, and therefore represents a complementary clinical parameter with diagnostic potential.

PMID:
30578784
DOI:
10.1016/j.ajo.2018.12.006

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