Evaluation of dry eye disase and meibomian gland dysfunction with meibography in seborrheic dermatitis

Ocular Manifestations in Seborrheic Dermatitis Epidemiology, Clinical Features, and Management: A Comprehensive Review

Seborrheic dermatitis (SD) often leads to ocular manifestations (OM) that are frequently overlooked. This study comprehensively explains the genesis of these ocular issues, which involves a combination of Malassezia overgrowth, changes in sebum production, and inflammatory responses in the body. The periocular region is rich in sebaceous glands, allowing Malassezia to thrive, which can lead to an inflammatory reaction that spreads to the eye surface, causing disorders such as blepharitis, conjunctivitis, keratitis, and ocular surface diseases. Although epidemiological data are limited, it is well established that ocular involvement occurs in approximately 10%-40% of individuals with SD. Early detection and treatment are crucial to prevent potential vision-threatening complications. A comprehensive diagnostic approach is necessary, including clinical examination, slit-lamp biomicroscopy, tear film analysis, and corneal imaging. Managing these conditions requires a multidisciplinary strategy involving collaboration between dermatologists and ophthalmologists. The treatment should involve topical and systemic medications to address the skin and ocular components. Patient education is critical for improving adherence to therapy, self-management, and the early identification of problems. In the future, it will be essential to investigate the intricate interactions between Malassezia species and host immunological processes. This collective effort will involve creating new biomarkers and diagnostic tools, investigating targeted immunomodulatory drugs and novel lipid-based medicines as potential treatments, and conducting large-scale longitudinal studies to understand the epidemiological patterns and prognostic variables better. By raising awareness, encouraging collaboration across disciplines, and advancing research, healthcare practitioners can significantly improve patients' quality of life with SD and OM.

Beyond dry eye: how co-morbidities influence disease phenotype in dry eye disease

Dry Eye Disease (DED) is a complex and multifactorial disorder of tear homoeostasis that results in pain, visual disturbance, and ocular surface damage. It is highly prevalent around the world and is associated with many co-morbidities that may contribute to or exacerbate symptoms and signs of disease and affect disease phenotype. However, DED is not one disease and can manifest with a variety of symptoms and/or signs. In this review, we discuss relationships between various co-morbidities and DED phenotypes. For example, individuals with immune mediated diseases, like Sjögren's Syndrome and Graft versus Host Disease, often present with aqueous tear deficiency (ADDE) in the setting of lacrimal gland dysfunction. Individuals with disorders that affect the periocular skin, like rosacea and seborrhoeic dermatitis, often present with evaporative dry eye (EDE) in the setting of eyelid and/or meibomian gland abnormalities. Individuals with pain related disorders, such as chronic pain syndrome and migraine, often present with ocular pain out of proportion to tear film abnormalities, often with accompanying corneal nerve hypersensitivity. Individuals with diabetes mellitus often present with an epitheliopathy in the setting of decreased sensation (neurotrophic keratitis). While not absolute, understanding relationships between co-morbidities and DED phenotypes can help tailor a therapeutic plan to the individual patient.

Characterization of Meibomian Gland Atrophy and the Potential Risk Factors for Middle Aged to Elderly Patients With Cataracts

Purpose

To explore the characteristics of meibomian gland (MG) atrophy and its potential risk factors in the age-related cataract population.

Methods

Patients who underwent cataract surgery at age 40 or older were enrolled in this study. Preoperative clinical measurement records were obtained, including lipid layer thickness, tear meniscus height, noninvasive breakup time, and meiboscore. The meibomian gland atrophy ratio (MGAR) was measured by the ImageJ software. Univariate regression analysis and multivariate regression analysis were used to analyze the risk factors for MG atrophy.

Results

Female patients had less atrophy of the MG compared with male patients. The MGAR, meiboscore, tear meniscus height (TMH), and lipid layer thickness (LLT) gradually increased with age. However, the noninvasive breakup time decreased with age. The multivariate regression analysis indicated that dyslipidemia and increased triglyceride levels were identified as independent protective factors for MG atrophy. We further stratified the model by sex, and the following results showed only in the female patients with dyslipidemia and increased triglyceride had decreased MG atrophy. No significant correlation was observed between MG atrophy and tear film parameters including TMH, noninvasive breakup time, and LLT.

Conclusions

Our study suggests that age, sex, and diabetes are potential risk factors for MG atrophy. In addition, dyslipidemia and increased triglyceride levels are independent protective factors for MG atrophy in the elderly female population.

Translational Relevance

MG atrophy is the leading cause of meibomian gland dysfunction. To study the characteristics and risk factors of MG atrophy in cataract patients would be helpful to predict and prevent postoperative development of MGD.

The role of meibography in ocular surface diagnostics: A review

The meibomian glands are lipid-secreting glands located in the tarsal plates, whose secretory products cover the tear film, thereby reducing evaporation as well as ensuring lubrication of the ocular surface. The meibomian glands can be visualized at different levels of magnification by infrared meibography, laser confocal microscopy, and optical coherence tomography. These imaging modalities have been subject to much research and progress in clinical practice and have shaped our current understanding of meibomian glands in health and disease. In this review, we explore the evolution of meibography over the past decades, the major contributions of various meibographic modalities, and discuss their clinical significance.