The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee

Is There a Difference Between Seropositive and Seronegative Sjögren Disease Dry Eye?

PURPOSE

The study aims to compare dry eye disease (DED) prevalence and severity between seropositive and seronegative Sjögren disease (SjD).

METHODS

Prospective, consecutive, comparative cross-sectional cohort study. A total of 160 eyes of 80 patients with SjD by The American College of Rheumatology and the European League Against Rheumatism 2016 criteria were included: 55 seropositive and 25 seronegative SjD. Associated SjD was excluded. Patients had dry eye tests performed. Generalized estimating equations were used to account for intereye correlation of the same participant.

RESULTS

Mean age was 52.2 ± 12.7, 96.3% were women, no differences were observed between groups (P > 0.05). Seronegative SjD had positive minor salivary gland biopsy more often (100% vs. 82%, P = 0.024), but with lower focus score (2.0 ± 1.2 vs. 4.1 ± 3.5, P = 0.006) than seropositive SjD group. DED prevalence was similar in seropositive and seronegative SjD (92.7% and 84%; P = 0.088). Only noninvasive break-up time (NIBUT) average was significantly reduced in seropositive SjD (6.6 ± 3.2 vs. 8.8 ± 2.4, P = 0.011), and the rest of the evaluated DED tests were not significant. In the seropositive group, nonstatistically significant trends toward more severe DED signs, including matrix metalloproteinase-9, osmolarity, Schirmer I without anesthesia, fluorescein tear break-up time, NIBUT first, and Sicca Ocular Staining Score, were observed. Both groups were highly symptomatic in ocular surface disease index score (43 ± 23 vs. 46 ± 30, P = 0.779) and had a reduction in quality of life in National Eye Institute visual health questionnaire-25 test (72 ± 21 vs. 70 ± 24, P = 0.650).

CONCLUSIONS

Patients with seropositive SjD showed significantly reduced NIBUT and a trend of more severe DED signs. Patients with seronegative and seropositive SjD were similarly highly symptomatic, experienced important reductions in vision-related quality of life, and had similar DED prevalence.

Intense Pulsed Light in the Treatment of Dry Eye and Meibomian Gland Dysfunction in Patients With Chronic Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

PURPOSE

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of dry eye disease and meibomian gland dysfunction associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

METHODS

This prospective noncomparative interventional study included 29 patients (58 eyes) who underwent 3 sessions of IPL and MGX at 2-week intervals. Subjective symptoms (ocular surface disease index score) and objective dry eye tests: matrix metalloproteinase 9, tear meniscus height, bulbar redness score, tear film lipid layer thickness (LLT), Schirmer I test, conjunctival and corneal staining, meibomian gland loss, MGX score [meibomian gland score (MGS)], and tear break-up time were assessed at the baseline and after 4, 8, and 12 weeks.

RESULTS

Twenty-nine individuals (57 eyes) were included in this analysis. The ocular surface disease index score decreased significantly from 60.07 ± 23.34 (baseline) to 38.36 ± 22.39 (after 90 days) (P < 0.01). The fluorescein and lissamine green staining scores, MGS, and LLT improved significantly (P < 0.01). In contrast, there were no significant changes in the tear meniscus height values, matrix metalloproteinase 9 positivity, bulbar redness score, Schirmer test, meibography of the superior and inferior eyelids, and tear break-up time. Ocular or skin complications were not observed.

CONCLUSIONS

Three IPL therapy sessions followed by MGX seemed to be safe and effective in treating dry eye disease and meibomian gland dysfunction, improving vision-related quality of life, dry eye symptoms, and ocular surface signs, such as corneal and conjunctival staining scores, MGS, and LLT after 90 days in patients with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

Epidemiology, Tear Film, and Meibomian Gland Dysfunction in Facial Palsy: A Comparative Analysis

Purpose

To compare the meibographies and dry eye parameters of paretic vs non-paretic sides of patients with a facial palsy diagnosis.

Patients and Methods

Twenty patients with unilateral facial palsy were recruited and the severity of the disease was staged using the House-Brackmann scale. A comprehensive dry eye evaluation was performed using the Oculus 5M Keratograph. A Pearson correlation coefficient was performed to determine correlation strength between House-Brackmann score and Meibomian gland atrophy. Meibographies were analyzed via ImageJ software to determine the affected area, and they were compared to the observer manual score. Cohen's Kappa coefficient was calculated to compare agreement between manual and ImageJ meibography scoring.

Results

Tear breakup time was reduced in the affected side (p = 0.21), tear meniscus height was much greater in the non-affected side (p = 0.02). Finally, Meibomian gland alterations were more evident in the affected side, with upper Meibomian glands having a loss of 29.55 ± 13.31% (p = 0.03) and lower glands presenting a loss of 44.44 ± 16.9% (p =< 0.001). Pearson correlation coefficient between House-Brackmann score and Meibomian gland atrophy was 0.841 (p < 0.001 [95% CI: 0.64-0.94]). Cohen's kappa coefficient was 0.643 (p < 0.001).

Conclusion

A clear difference in Meibomian gland and tear film dynamics can be observed in paretic vs non-paretic sides. A greater House-Brackmann score was correlated with a greater Meibomian gland atrophy area. A strong positive correlation is seen between the House-Brackmann score and Meibomian gland atrophy. Software-based analysis also showed a greater glandular area loss when compared to clinician's analysis. The level of agreement was moderate, so disparities are observed, especially in grade 2 Meibomian gland dropout where the least level of agreement was seen in cross tabulation. This study further incentivizes multimodal patient evaluation, which has been a growing area of interest in healthcare.

An update on emerging pharmacological treatments for meibomian gland dysfunction

INTRODUCTION

Meibomian Gland Dysfunction (MGD) represents the most common cause of dry eye disease (DED). Traditional treatments mainly rely on heating and liquifying the meibum to favor its expression. However, recent knowledge advances have led to the development of novel therapies specifically designed for patients with MGD.

AREAS COVERED

Literature search was conducted on current and novel treatments for MGD. Conventional treatment strategies, non-pharmacological approved device-based therapies, approved dry eye therapies and both recently approved and emerging pharmacological treatments specifically designed to address MGD are discussed.

EXPERT OPINION

The better understanding of MGD and DED pathophysiology has allowed to develop drugs able to target the primary mechanisms of the disease. Miebo has been the first FDA approved drug for patients with DED associated with MGD and its ability to reduce the tear film layer evaporation rate and the minimal impact on the quality of vision are important innovations. Great expectations also accompany the phase 3 study of AZR-MD-001, understood to be a keratolytic and lipogenic agent able to improve meibum quantity and quality. The chance to specifically target MGD represents an important step forward and will allow more tailored treatment for each type of ocular surface disease.

Efficacy and safety of AZR-MD-001 selenium sulfide ophthalmic ointment in adults with meibomian gland dysfunction over six months of treatment: A Phase 2, vehicle-controlled, randomized extension trial

PURPOSE

To determine the efficacy and safety of AZR-MD-001 (0.5 % and 1.0 %) ophthalmic ointment, relative to vehicle, over 3-6 months of treatment, in participants with meibomian gland dysfunction (MGD).

METHODS

This was a Phase 2, randomized, vehicle-controlled, multicenter extension clinical trial. Eligible participants were adults with MGD (meibomian gland secretion score (MGS) ≤12 out of 15 glands) who discontinued all other dry eye or MGD treatments. Participants were randomized 1:1:1 to apply AZR-MD-001 1.0 %, 0.5 %, or vehicle to the lower eyelids, twice weekly. Key exploratory endpoints included the least-squared mean difference between groups in the change from baseline in clinical signs (meibomian gland yielding score; MGYLS) and symptoms (Ocular Surface Disease Index; OSDI), at clinic visits at Month 4.5 and 6, and safety measures from 36 months.

RESULTS

Participants (66.5 % female) were randomized, at baseline, to AZR-MD-001 0.5 % (n = 82), 1.0 % (n = 83), or vehicle (n = 80). Statistically significant improvements, compared to vehicle, were observed at Month 6 in MGYLS for both AZR-MD-001 groups (0.5 % group: 1.9, 95 % CI 0.9 to 2.8, P = 0.002; 1.0 % group: 1.1, 95 % CI 0.2 to 2.1, P = 0.026), and in OSDI score for the 0.5 % group (-4.5, 95 % CI -8.0 to -0.9, P = 0.0135). The most common adverse events for AZR-MD-001 were application site pain, superficial punctate keratitis and eye pain; most were mild to moderate in severity, and decreased in incidence over time.

CONCLUSIONS

AZR-MD-001 (0.5 %) was efficacious in treating signs and symptoms of MGD over six months, with a lower observed incidence of new adverse events over time.

AZR-MD-001 0.5% selenium sulfide ophthalmic ointment for the treatment of contact lens discomfort: A vehicle-controlled, randomized, clinical trial

BACKGROUND

Contact lens discomfort (CLD) is a common problem for CL wearers, and patients with CLD often have changes in meibomian gland function and structure. In a Phase 2 trial AZR-MD-001 0.5% (AZR) ophthalmic ointment improved meibomian gland dysfunction (MGD) in non-lens wearers. The current study evaluated the efficacy and safety of AZR in participants with CLD and concomitant MGD.

METHODS

Adults with CLD (Contact Lens Dry Eye Questionnaire-8 >12, range 0-37) and MGD (Meibomian Gland Secretion Score [MGS] ≤12, range 0-45) were randomized (1:1) to AZR:vehicle applied twice-weekly in a three-month multicenter, prospective, double-masked study. Endpoints included difference in change from baseline (CFB) in the number of Meibomian Glands Yielding Liquid Secretion (MGYLS), MGS, the ability to wear their lenses as long as desired, and safety.

RESULTS

At Month 3, AZR (n = 34) significantly increased the MGYLS and MGS versus vehicle (n = 33), with least squares mean difference (LSMD) CFB in MGYLS of 5.0 (SE = 0.47) for AZR and 1.6 (0.45) for vehicle, P < 0.0001; MGS of 13.8 (SE = 0.67) for AZR and 3.8 (SE = 0.68) for vehicle, P < 0.0001. Significantly more participants treated with AZR were able to wear lenses as long as desired (43% vs. 6%, P = 0.0023). The most common treatment-emergent adverse event (TEAE) was eye irritation (61.8% AZR; 0% vehicle). All TEAEs related to treatment were mild/moderate, transient, and did not result in discontinuation.

CONCLUSION

AZR-MD-001 0.5% significantly improved MGD signs and hours of comfortable CL wear, demonstrating good efficacy, safety, and tolerability in those with CLD.

Randomized clinical trial: MGrx versus standard debridement and expression for meibomian gland dysfunction

SIGNIFICANCE

Evaporative dry eye disease, due to meibomian gland dysfunction, causes significant suffering for millions of people globally, yet satisfactory long-term treatment remains elusive for many. Investigation of potential therapies for meibomian gland dysfunction is therefore of high importance to clinicians and their patients.

PURPOSE

This study aimed to compare the efficacy of a new device for meibomian gland debridement and expression to that of the conventional way of providing this treatment.

METHODS

Thirty participants (mean age, 36.4 ± 15.4 years; 77% female) fulfilling current Tear Film & Ocular Surface Society diagnostic criteria for dry eye disease and meibomian gland dysfunction were recruited (Research Registry, 10340). Fifteen participants each were randomized to receive a single treatment with either traditional debridement (using a golf-club spud), heating (10 minutes of Blepha EyeBag, Théa Laboratories, Clermont-Ferrand, France) and expression (with forceps), or the multimodal MGrx, which comprises a handheld device with heated debridement, massage, and expression attachments. Symptomatology, tear film, and ocular surface measures were assessed at baseline and at 4 and 8 weeks post-treatment.

RESULTS

Ocular Surface Disease Index, 5-Item Dry Eye Questionnaire, and Symptom Assessment in Dry Eye symptom questionnaire scores all improved significantly with both treatments (all p<0.001), with no subsequent deterioration for at least 8 weeks. The improvement was similar between treatment groups (all p>0.05). Clinical signs, of blink rate, tear film quality and quantity, ocular surface characteristics, and meibomian gland expressibility, were all unchanged with both treatments (all p>0.05) except for noninvasive tear breakup time, which deteriorated in the conventional treatment group (p=0.006) between 4 and 8 weeks post-treatment. No adverse reactions were reported, and all participants were able to tolerate treatment.

CONCLUSIONS

A single application of meibomian gland debridement and expression resulted in sustained improvements in the symptoms of dry eye disease, in both treatment groups. The MGrx device provides a safe and effective in-office treatment for evaporative dry eye disease, and has time and space advantages compared with conventional treatment.

Treatment of Meibomian Gland Dysfunction by Classical Eyelid Hygiene Measures With and Without Additional Lipid Substitution for Tear Film Stabilization

OBJECTIVE

This study aimed to document the treatment success of eyelid hygiene with liposomal suspension using new diagnostic tools and to determine whether additional lipid substitution provided measurable benefits in meibomian gland dysfunction.

METHODS

A single-center controlled, partially single masked study was conducted. Group A used eyelid hygiene only, whereas group B additionally applied a liposomal eye spray. Subjective perception using the Ocular Surface Disease Index (OSDI) questionnaire, measurement of tear film osmolarity, noninvasive tear film break-up time, assessment of the lipid layer, meibography, inspection of lid margins, assessment of the meibomian glands, and measurement of matrix-metallopeptidase-9 were collected at baseline and after 12 weeks.

RESULTS

Eighty-two patients were included and randomized into two groups. Both groups showed a decrease in OSDI score (P<0.001), an increase in lipid layer thickness (P<0.001), significant improvement in the degree of loss of meibomian glands (P<0.001), in the damage pattern of the eyelid margins (P<0.001), in the quality of meibomian gland secretion, and in matrix-metallopeptidase-9 after 12 weeks.

CONCLUSIONS

Our study confirms the success of treatment with eyelid hygiene measures using a liposomal suspension. The additional benefit of lipid substitution was not significant after 12 weeks of treatment.

SMILE and ICL implantation on the ocular surface and meibomian glands in patients with postoperative myopia

BACKGROUND

Objectively compare the changes in ocular surface parameters in myopic patients who have undergone either SMILE or Implantable Collamer Lens (ICL V4c) surgery.

METHODS

This prospective cohort study enrolled 32 patients (32 eyes) undergoing SMILE surgery and 35 patients (35 eyes) receiving ICL V4c intraocular lenses. Examinations were performed at preoperative, 1-week, 1-month, and 3-month postoperative time points. The assessments included Schirmer's I Test (SIt), First Non-Invasive Break-Up Time (First-NIBUT), Average Non-Invasive Break-Up Time (Average-NIBUT), Tear Meniscus Height (TMH), Ocular Surface Disease Index (OSDI) score, conjunctival congestion score, meibomian gland loss score, lipid layer analysis score, lid margin opening detection score, and corneal fluorescein staining (CFS) score.

RESULTS

Repeated measures ANOVA revealed that SIT, TMH, and First-NIBUT initially decreased and then increased. At three months, SIT levels in the SMILE group were significantly lower than those in the ICL group. From the first month onward, TMH levels in the SMILE group remained significantly lower than those in the ICL group (P < 0.05). OSDI scores initially rose and then fell, with the SMILE group consistently showing higher OSDI levels than the ICL group. Conjunctival congestion scores in the SMILE group fluctuated less, while the ICL group exhibited a clear downward trend, with significant differences starting from the first week (P < 0.05). Over time, scores for meibomian gland loss, lipid layer analysis, and lid margin opening detection were all higher in the SMILE group compared to the ICL group.

CONCLUSIONS

SMILE surgery has a more pronounced and prolonged impact on the ocular surface and meibomian gland function compared to ICL implantation. Objective dry eye parameters in the ICL group recover more quickly than those in the SMILE group one month post-surgery.

Low-level light therapy and intense pulse light therapy in meibomian gland dysfunction. A systematic review and meta-analysis

BACKGROUND

Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease, affecting over a third of the global population. This disease is associated with ocular discomfort, reduced visual quality, and quality of life. Novel treatments like Intense Pulse Light (IPL) therapy and Low-Level Light Therapy (LLLT) have been reported to be useful in refractory MGD treatment. However, no systematic review has explored the utility of combining these two therapies.

METHODS

Medline, Embase, and CENTRAL databases were searched for articles on LLLT + IPL therapy in MGD. A meta-analysis of single means was conducted to assess clinical endpoints.

RESULTS

Analysis of 12 studies showed that LLLT + IPL therapy in MGD patients led to a significant decrease in Ocular Surface Disease Index score (MD: -22.8, 95 %CI: -29.1 to -16.5, I2 = 97.5 %, p < 0.001), and a significant increase in both Tear Break-up Time (MD: 2.2 s, 95 %CI: 0.9 s to 3.4 s, I2 = 98.6 %, p < 0.001) and Schirmer test (MD: 1.5 mm, 95 %CI: 0.6 mm to 2.5 mm, I2 = 0.0 %, p = 0.001) at ≤ 3 months post treatment. These improvements were sustained in a sensitivity analysis at endpoints ≥ 6 months post treatment. While the percentage of loss of meibomian gland area (n = 4, MD: -3.8 %, 95 %CI: -7.2 % to -0.4 %, I2 = 40.0 %, p = 0.031) was reported to be significantly reduced, this was not found to be sustained at endpoints ≥ 6 months post treatment (n = 2, MD: 5.9 %, 95 %CI: 1.8 % to 10.0 %, I2 = 0.0 %, p = 0.005) in two studies.

CONCLUSIONS

This meta-analysis provides quantitative evidence supporting the clinical efficacy of LLLT + IPL therapy in MGD. Future research should evaluate its long-term safety and efficacy and compare it with alternative treatments.

Correlation between meibomian gland dysfunction and sebaceous adenitis in dogs

BACKGROUND

Sebaceous adenitis (SA) is an immune-mediated disease targeting the sebaceous glands. Meibomian gland dysfunction is a disease affecting meibomian glands with inflammatory features. Sebaceous and meibomian glands share anatomical, physiological and embryological similarities. The involvement of meibomian glands in dogs with SA is currently unknown.

OBJECTIVES

To evaluate meibomian glands in dogs affected by SA and compare them with healthy dogs.

ANIMALS

Eighteen dogs were enrolled. Nine dogs with SA were retrospectively identified from clinical records and represented the case group. Nine healthy, breed- and age-matched dogs were prospectively enrolled in the control group.

MATERIALS AND METHODS

Both groups underwent dermatological examination, Schirmer tear test-1 (STT-1), tear meniscus height (TMH), slit-lamp biomicroscopy, interferometry (INT) and noncontact infrared meibography (NIM).

RESULTS

One third of SA dogs presented subepithelial crystalline opacities. No significant difference between groups was observed in TMH (p = 0.944) and STT-1 values (p = 0.066). INT (p = 0.016) and NIM grades (p = 0.010) were significantly higher and lower in the SA group compared to the control group, respectively. INT values decreased with age (η = 0.930), while NIM scores (η = 0.935) increased.

CONCLUSIONS

Clinical Relevance: Subepithelial crystalline opacities in SA dogs might reflect a reduced tear film quality. In the absence of standardised methods, INT and NIM proved to be noninvasive and useful methods to examine meibomian glands. Dogs with SA showed a thinner lacrimal lipid layer and more severe meibomian gland abnormalities than control dogs, which seemed to progress with age.

Epidemiological survey of anterior segment diseases in Japanese isolated island using a portable slit-lamp device in home-based cases in Miyako Island

The ophthalmic diseases often affect the elderly and require proper diagnosis, treatments, and follow ups. However, many cases lack adequate eye care due to limited resources and decreased daily living activities among individuals. Despite the importance of ophthalmic home care, epidemiological research in this area has been lacking. This study utilized portable ophthalmological equipment to conduct an epidemiological research of anterior segment diseases in patients receiving home-based medical care in Japanese isolated island "Miyako island". A retrospective examination was conducted on home visit cases from a single facility in Miyako island (Dr. Gon Clinic). Data from 147 cases were collected and analyzed which the data are all recorded by the home care doctors and send the data to the cloud in order to make a diagnosis by the ophthalmologists. Findings included various anterior segment eye diseases such as Ptosis, meibomian gland dysfunction, conjunctival chalasis, corneal opacity, conjunctival hyperemia, pterygium, and cataract. Notably, over half of the cases (51.67%) had not undergone cataract surgery although the average age are notably high (85.69 ± 12.11 age of years). Among those without surgery, all showed signs of moderate to severe cataracts, with severity increasing with age. Additionally, a shallow anterior chamber depth was observed in one-third of these cases (33.63%) which considerable to receive a surgery to prevent the acute glaucoma attack. From our study, to ensure that patients in remote islands as Miyako island do not miss opportunities for eye care, there is an urgent need for the establishment of a supportive medical system.

How Eyelid Changes May Impact on Tears

This article examines the impact of eyelid margin diseases on tear film composition and associated ocular surface disorders. It highlights the prevalence of blepharitis and meibomian gland dysfunction, discussing risk factors and diagnostic considerations. Various therapeutic approaches, including eyelid hygiene, antibiotics, and innovative treatments, are explored. Emphasizing the chronic nature of these conditions, the article underscores the need for patient compliance. Overall, it provides a concise overview of eyelid-related issues and potential management strategies.

LipiFlow for the treatment of dry eye disease: A Cochrane systematic review summary

PURPOSE

To evaluate the effectiveness and the safety of LipiFlow for treating signs and symptoms of dry eye disease (DED) in adults.

METHODS

The following databases were searched for randomized trials: CENTRAL, MEDLINE Ovid, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and WHO ICTRP on 24 October 2022. The included studies were conducted in adults (≥18 years) with DED or meibomian gland dysfunction (MGD) as defined by the investigators. Standard Cochrane methodology was applied.

RESULTS

This study included 13 trials that randomized a total of 1,155 participants (66 % female; age range = 19 to 86 years). Five trials compared LipiFlow with basic warm compresses. Analyzing symptom scores in these trials yielded conflicting evidence of a difference in symptoms between LipiFlow and basic warm compresses after 4 weeks. There was no evidence of a difference in meibomian gland expression, meibum quality, or tear breakup time when comparing LipiFlow with basic warm compresses. Another 5 trials compared LipiFlow with thermostatic devices. Analysis of symptom scores in these trials at 4 weeks showed that thermostatic devices had reduced Ocular Surface Disease Index (OSDI) scores by a mean difference of 4.59 as compared with LipiFlow. The remaining 3 included trials could not be grouped for comparisons. The overall evidence was of low or very low certainty, with most trials being assessed as having a high risk of bias. No trial reported any intervention-related, vision-threating adverse events.

CONCLUSIONS

LipiFlow performs similarly to other DED treatments. Further research with adequate masking and a standardized testing methodology is still needed.

Efficacy of indirect intense pulsed light irradiation on meibomian gland dysfunction: a randomized controlled study

AIM

To investigate the efficacy and mechanisms of indirect intense pulsed light (IPL) irradiation on meibomian gland dysfunction (MGD).

METHODS

A total of 60 MGD patients was included in this prospective randomized controlled trial. Patients were randomly assigned 1:1 into two groups (3-mm group and 10-mm group) in which IPL was applied at distances from the lower eyelid margin of 3 and 10 mm, respectively. Both groups received three times treatment with 3-week interval. Meibomian gland yield secretion score (MGYSS), standard patient evaluation of eye dryness (SPEED) questionnaire, tear break-up time (TBUT), corneal fluorescein staining (CFS), and in vivo confocal microscopy were performed at baseline and after every treatment.

RESULTS

After three IPL treatments, both groups had significant improvement in MGYSS (both P<0.05). The non-inferiority test showed that improvement in 10-mm group was not inferior to that in 3-mm group (P<0.001). In both groups, temporal regions of both upper and lower eyelids showed significant improvement in MGYSS. Scores of SPEED questionnaire in both groups declined significantly (both P<0.001) and changes of SPEED had no difference between two groups (P=0.57). Density of central corneal subepithelial nerves and TBUTs showed no statistically significant changes. The 3-mm group had improvement on corneal fluorescein staining (P=0.048) and meibomian gland morphology (acini wall thickness P=0.003, hyperreflective points P=0.024) while the 10-mm group had not.

CONCLUSION

The efficacy of IPL indirect irradiation in improving meibomian gland secretion and alleviating dry eye symptoms remains unchanged with increase in treatment distance. IPL may primarily act on the functional improvement of the meibomian glands and corneal nerves.

Diagnostic performance of qualitative and quantitative methods of meibomian gland dropout evaluation in dry eye disease: An investigator-masked, randomised crossover study

PURPOSE

To evaluate the discriminative abilities and optimal cut-off values of qualitative meiboscale grading and percentage meibomian gland dropout measurements from each of two instruments (Keratograph 5M and LipiView II) in detecting dry eye disease, as defined by the TFOS DEWS II criteria.

METHODS

A total of 227 community residents (143 females, 84 males; mean ± SD age, 36 ± 15 years) were recruited in a prospective, investigator-masked, randomised, crossover study. Dry eye symptomology, tear film parameters, and ocular surface characteristics were evaluated in a single clinical session. Qualitative meiboscale grading and quantitative percentage gland dropout assessment using Image J software were evaluated by independent masked assessors, in a randomised order.

RESULTS

Overall, 92 (41 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease. The diagnostic performances for percentage meibomian gland dropout measurements (C-statistic range, 0.629 to 0.647) were significantly greater than qualitative meiboscale grading (C-statistic range, 0.547 to 0.560) for both instruments. The Youden-optimal diagnostic cut-off percentage gland dropout was > 20 % and optimal threshold meiboscale grade was > 1 for both superior and inferior eyelid measurements from the two instruments. Inter-instrument weighted Cohen's kappa coefficients for meiboscale grading were 0.734 and 0.682, respectively, and Bland-Altman biases (95 % limits of agreement) for percentage gland dropout were -1.8 % (-28.1 % to 24.4 %) and -1.5 % (-29.3 % to 26.2 %), respectively.

CONCLUSIONS

Despite exhibiting comparable discriminative abilities, meibography parameters obtained from the Keratograph and LipiView were not directly interchangeable. Overall, percentage gland dropout measurements demonstrated superior diagnostic performance, which would support their use in clinical trials and epidemiology studies, where practicable.

Evaluation of ocular surface inflammation and systemic conditions in patients with systemic lupus erythematosus: a cross-sectional study

OBJECTIVE

The cross-sectional study was designed to evaluate the association of ocular surface inflammation with systemic conditions in patients with systemic lupus erythematosus (SLE).

METHODS

The study enrolled 30 SLE patients and 30 controls. Ocular symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Tear samples from all participants were collected for tear multi-cytokine and chemokine concentration analysis. All participants were assessed for dry eye disease (DED), including Schirmer I test, tear break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland secretion (MGS), lid-parallel conjunctival folds (LIPCOF), corneal clarity, and symblepharon. Besides, all participants were also examined for conjunctival impression cytology to measure the density of conjunctival goblet cells (CGCs). The peripheral blood indicators from SLE patients were also collected to measure the SLE-associated autoantibody specificities and systemic inflammatory indicators. Pearson and Spearman's analysis were uesd to examine the correlation between tear cytokines, CGCs, DED-related indicators, and systemic conditions.

RESULTS

The two groups were matched for age and gender in this study. 36.67% of eyes (11 in 30) of SLE patients and 13.33% of eyes (4 in 30) of controls were diagnosed with DED. OSDI scores, abnormal TBUT percentages, CFS percentages, and DED grading were all higher in SLE patients than in control group, while density of CGCs was lower. There were no significant differences in Schirmer I test, MGS, LIPCOF, corneal clarity, and symblepharon between SLE patients and controls. The levels of tear chemokine (C-X-C motif) ligand 11 (CXCL11) and cytokine interleukin-7 (IL-7) in patients with SLE were significantly higher than those in control group. Moreover, among SLE patients, the severity of DED and the level of tear chemokine CXCL11 were significantly positively correlated with SLE-associated autoantibody specificities.

CONCLUSION

Dry eye and tear cytokines and chemokines-mediated ocular surface inflammation persist in SLE patients and are associated with systemic conditions. Therefore, it is necessary for patients with SLE to combine systemic and ocular assessments.

In vivo lacrimal gland imaging artefact assessment based on swept-source optical coherence tomography for dry eye disease

BACKGROUND

This study aimed to characterise imaging artefacts in the lacrimal gland using swept-source optical coherence tomography (SS-OCT) in patients with dry eye disease (DED) and healthy participants and identify risk factors for these artefacts.

METHODS

In total, 151 eyes, including 104 from patients with DED and 47 from non-DED participants, were analysed. Demographic data collection, comprehensive ocular examinations and SS-OCT imaging of the palpebral lobe of the lacrimal gland were performed. Artefacts were classified into distinct categories with different severities. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, gender, best-corrected visual acuity, intraocular pressure (IOP) and the presence of DED with the presence of artefacts.

RESULTS

Eight artefact types and severity grading were defined by analysing 1208 lacrimal SS-OCT images. The three most prevalent artefacts were defocus (75.83%), cliff (67.47%) and Z-off (58.44%). The presence of artefacts was significantly associated with the presence of DED (OR=9.13; 95% CI, 2.39 to 34.88; p=0.001) and higher IOP (OR=1.34; 95% CI, 1.14 to 1.58; p<0.001). Furthermore, multivariate logistic analyses showed that lower tear film breakup time (OR=0.71; 95% CI, 0.55 to 0.92; p=0.009) and higher meibum quality score (OR=2.86; 95% CI, 1.49 to 5.48; p=0.002) were significantly associated with higher odds for the presence of artefacts.

CONCLUSIONS

DED eyes had more SS-OCT image artefacts than normal eyes. Stringent standardised image quality control should be implemented before further image analysis when using SS-OCT to assess lacrimal gland image.

Advances in artificial intelligence for meibomian gland evaluation: A comprehensive review

Meibomian gland dysfunction (MGD) is increasingly recognized as a critical contributor to evaporative dry eye, significantly impacting visual quality. With a global prevalence estimated at 35.8 %, it presents substantial challenges for clinicians. Conventional manual evaluation techniques for MGD face limitations characterized by inefficiencies, high subjectivity, limited big data processing capabilities, and a dearth of quantitative analytical tools. With rapidly advancing artificial intelligence (AI) techniques revolutionizing ophthalmology, studies are now leveraging sophisticated AI methodologies--including computer vision, unsupervised learning, and supervised learning--to facilitate comprehensive analyses of meibomian gland (MG) evaluations. These evaluations employ various techniques, including slit lamp examination, infrared imaging, confocal microscopy, and optical coherence tomography. This paradigm shift promises enhanced accuracy and consistency in disease evaluation and severity classification. While AI has achieved preliminary strides in meibomian gland evaluation, ongoing advancements in system development and clinical validation are imperative. We review the evolution of MG evaluation, juxtapose AI-driven methods with traditional approaches, elucidate the specific roles of diverse AI technologies, and explore their practical applications using various evaluation techniques. Moreover, we delve into critical considerations for the clinical deployment of AI technologies and envisages future prospects, providing novel insights into MG evaluation and fostering technological and clinical progress in this arena.

A novel nomogram to predict glucocorticoid response in thyroid-associated ophthalmopathy: findings from a pilot study

PURPOSE

Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO).

METHODS

This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for "unresponsiveness" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model's discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis.

RESULTS

The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73-0.91), affirming the model's consistent and reliable ability to distinguish between responsive and non-responsive TAO patients.

CONCLUSION

Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients.

Therapeutic effectiveness of different machines in intense pulsed light treatment of meibomian gland dysfunction

Purpose

This study aimed to determine the therapeutic effectiveness of different machines in intense pulsed light (IPL) treatment of meibomian gland dysfunction (MGD).

Methods

213 subjects diagnosed with MGD underwent three sessions of IPL treatment in a control (M22) treatment group or experimental (OPL-I) treatment group and were followed up three to four weeks after each session. Tear breakup time (TBUT), meibomian gland secretion scores (MGSS), meibomian gland meibum scores (MGMS), corneal fluorescein staining (CFS) scores, and the Standard Patient Evaluation of Eye Dryness (SPEED) was used to assess eye dryness signs and symptoms at baseline and follow-up visits.

Results

Two machines had the same working principles except that experimental (OPL-I) group consist of a dual filter system. Both groups showed significant improvements (P ​< ​0.0001) in TBUT, MGSS, MGMS, CFS scores and SPEED scores. Non-inferiority analysis showed no statistically significant differences in any result between the two groups. Various defects appeared on the filter with the extension of usage time. Spectrophotometry showed that light intensity decreased to 93.5% ​± ​0.46% past the first filter.

Conclusions

IPL treatment completed with different machines have the same effect on improving the symptoms and signs of MGD. The dual filter system in the IPL machine reduces light intensity by approximately 6.5% without affecting its therapeutic effect. It is a feasible measure to ensure double safety and has the significance of popularization not only for MGD but also in other IPL treatment scenarios.

Effect of low-level light therapy in individuals with dry eye disease

INTRODUCTION

Low-level light therapy (LLLT) or photobiomodulation, the application of red light to the eye, is used for the treatment of dry eye. Limited studies have investigated the efficacy of LLLT as a stand-alone treatment. The investigation aimed to evaluate the effect of LLLT on signs and symptoms of dry eye.

METHODS

Participants with mild to moderate dry eye were recruited for this three-visit study. Visits were 7 (±3) days apart and all participants received 633 nm LLLT (eye-light®) for 15 min at each visit. Clinical measures including first and average non-invasive keratograph tear break-up time (NIKBUT), tear meniscus height (TMH), meibomian gland (MG) loss for upper and lower eyelids, ocular surface disease index (OSDI) score, tear film lipid layer thickness, meibum quality score, Schirmer's test, corneal fluorescein staining and eyelid temperature for external upper (EUL) and external lower (ELL) eyelids were measured from the right eye of participants before and after treatment.

RESULTS

Thirty participants (mean [SD] age: 31.1 [9.5] years) completed the study. Treatment with LLLT resulted in significant differences in first and average NIKBUT, TMH, tear film lipid layer thickness, OSDI score, Schirmer's test, meibum quality score and eyelid temperature over time (all p < 0.05). Compared to baseline, TMH, tear film lipid layer thickness and eyelid temperature significantly increased by 0.06 mm (95% CI: 0.01-0.11), 12.9 nm (95% CI: 1.18-24.55), and 7.0°C, respectively, for both EUL (95% CI: 6.17-7.84) and ELL (95% CI: 6.17-7.73). The respective decrease in the OSDI score and Schirmer's test was 10.2 (95% CI: -15.15 to -5.26) and 4.4 mm (95% CI: -7.31 to -1.42; all p < 0.05). There was no significant difference in corneal fluorescein staining and MG loss after LLLT.

CONCLUSION

Low-level light therapy treatment significantly improved signs and symptoms of dry eye in the early phases of treatment, suggesting its efficacy for dry eye management.

The efficacy of a netilmicin/dexamethasone gel combination in the treatment of posterior blepharitis in moderate-severe dry eye patients

PURPOSE

To evaluate the safety and efficacy of netilmicin/dexamethasone combination in the treatment of meibomian gland dysfunction (MGD)-associated posterior blepharitis.

METHODS

In this prospective and controlled study were enrolled 40 patients with MGD and symptoms of dry eye disease. Two groups were established: 20 patients (group 1) received netilmicin 3 mg/ml and dexamethasone 1 mg/ml eye gel, whereas in group 2 (20 patients) received vehicle for 15 days. Patients were evaluated at baseline, 15 and 45 days, including SANDE and VARS questionnaire, non-invasive tear film breakup time (NIBUT), tear meniscus height (TMH), ocular redness and meibography score. Moreover, fluorescein tear-film breakup time (TBUT), fluorescein ocular surface staining, lid margin evaluation including hyperemia, edema and meibum expressibility and quality examinations were carried out. Furthermore, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were considered as safety parameters.

RESULTS

In group 1, at 15 and 45 days there were statistically significant changes in VARS and SANDE score (p < 0.0001) as well as lid margin parameters, TBUT and fluorescein ocular surface staining (p < 0.0001). Comparing the two groups, a significant improvement of SANDE score was observed at 15 days in group 1 as well as lid margin parameters, TBUT and fluorescein ocular surface staining at 15 and 45 days (all p < 0.0001).

CONCLUSION

Netilmicin/dexamethasone combination is effective and safe to treat MGD-associated posterior blepharitis improving both symptoms and ocular surface signs.

Comprehensive Assessment of the Meibomian Glands by Meibography: Why the Upper Eyelids Matter

ABSTRACT

The clinical value of upper eyelid meibographic imaging remains relatively underexplored; consequently, it is not commonly used in clinical assessments. However, its significance could be particularly important for the early detection of various ocular diseases and systemic conditions related to the eyes. An analysis of the current literature from the PubMed database, covering the years 2005 to 2023, with additional relevant papers added from cited references was conducted. Failure to diagnose dry eye disease and meibomian gland dysfunction associated with conditions such as Sjögren syndrome or thyroid eye disease in the early stages and taking appropriate action may result in persistent signs and symptoms. This could potentially lead to the development of chronic conditions that directly affect a patient's visual quality, functionality, and overall well-being. Therefore, this review aimed to demonstrate the potential clinical significance of upper eyelid examination as an integral component of comprehensive meibomian gland evaluation.

Therapeutic Efficacy and Safety of Intense Pulsed Light for Meibomian Gland Dysfunction in Patients with Chronic Ocular Graft-Versus-Host Disease

PURPOSE

To evaluate the efficacy and safety of intense pulsed light combined with meibomian gland expression (IPL-MGX) for treating meibomian gland dysfunction (MGD) associated with chronic ocular graft-versus-host disease (oGVHD).

METHODS

This retrospective study included 18 patients (18 eyes) with Fitzpatrick skin type ≤ IV, who underwent 3 to 8 sessions of IPL-MGX. Dry eye symptomology, ocular surface parameters, and adverse events were evaluated.

RESULTS

 Of 18 eyes, 83.3% and 66.7% showed severe oGVHD and severe MGD, respectively. At 4 weeks after the final session, significant improvements in the OSDI (P < 0.001), SPEED (P = 0.001), meibum expressibility (P < 0.001), and meibum quality (P = 0.016) were observed. At 12 weeks after, the OSDI (P = 0.009), SPEED (P = 0.002), and meibum expressibility (P = 0.008) significantly improved. No adverse events owing to IPL were reported.

CONCLUSION

IPL-MGX may improve the ocular symptoms, ameliorate meibomian gland secretion, and is considered as a safe treatment for MGD in oGVHD patients.

Delayed diagnosis of ocular graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

PURPOSE

To investigate the delayed diagnosis of chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (alloHCT), and further analyze potential confounding factors.

METHODS

This cross-sectional study included 118 patients newly diagnosed as coGVHD after alloHCT at Zhongshan Ophthalmic Center, Sun Yat-sen University. All participants finished the flow path of medical history taking, detailed ophthalmological examination and questionnaire-based survey. coGVHD was diagnosed and graded by International Chronic Ocular GVHD Consensus Group (ICOGCG) criteria. Lag time of diagnosis was defined as interval between noting of ocular symptoms and confirmed diagnosis of coGVHD (TN-D). We further compared the clinical parameters between groups categorized by the median TN-D as medium and long delay groups.

RESULTS

The median TN-D was 6.3 [IQR 2.8-14.5] months. Most coGVHD patients underwent delayed diagnosis of coGVHD longer than 3 months (70 %, 83 of 118), with 90 of 118 diagnosed as severe coGVHD (76 %). The long delay group exhibited higher ICOGCG scores (10 [IQR 9-10.5] vs. 9 [IQR 8-10], P = 0.039) and more pronounced ocular signs, including conjunctival injection, meibomian gland loss, fibrotic tarsal conjunctiva, symblepharon, and corneal complications (all P < 0.05). Delayed diagnosis was strikingly correlated with seeking ophthalmic medical care twice or more prior to diagnosis (adjusted OR = 5.42, 95%CI: 1.40-21.06, P = 0.015) and accurate knowledge of ocular discomfort symptoms in coGVHD (adjusted OR = 0.29, 95%CI: 0.08-1.00, P = 0.050).

CONCLUSIONS

Delayed diagnosis of coGVHD, associated with disease severity, was common among alloHCT recipients in southern China. Improving patient education and the awareness of ophthalmologists may facilitate early diagnosis of coGVHD.

Comparison of upper eyelid pressure and ocular surface parameters in dry eye disease and benign essential Blepharospasm: A cross-sectional study

PURPOSE

To compare the upper eyelid pressure (UEP) and ocular surface parameters between dry eye disease (DED) and DED coexisting with benign essential blepharospasm (BEB), exploring which parameters could assist in distinguishing between DED and BEB, as potential risk factors for DED with BEB.

METHODS

All enrolled participants diagnosed with DED or DED coexisting with BEB were initially subjected to ocular surface disease index (OSDI) determination. Subsequently, the upper eyelid pressure was recorded using an innovative eyelid pressure measurement device, followed by a series of ocular surface examinations. The two groups were compared using the independent t-test and Mann-Whitney U test. A logistic regression analysis was performed to identify which parameters can predict the onset of blepharospasm.

RESULTS

The BEB group achieved a higher upper eyelid pressure (101.9 ± 23.5mN vs 88.4 ± 18.1mN, P = 0.009), lower number of total blink (6.2 ± 4.2 vs 7.1 ± 4.1, P = 0.016), higher corneal fluorescein staining score (4.0 ± 1.9 vs 3.0 ± 1.7, P = 0.046), higher partial blink rate (0.9 ± 0.2 vs 0.5 ± 0.4, P = 0.000) and the lower grade of meibum expressibility (1 (1, 2) vs 2 (1, 3), P = 0.000) and meibum quality (1 (1, 1) vs 1 (1, 1), P = 0.033) compared with the DED group. The upper eyelid pressure (OR = 1.123), partial blink rate (OR = 0.014) and the grade of meibum expressibility (OR = 10.804) showed significant associations with BEB (P < 0.05).

CONCLUSION

Despite similar OSDI scores, DED coexisting with BEB exhibited higher upper eyelid pressure, lower corneal fluorescein staining score, lower partial blink rate, more total blinks, lower grades of meibum expressibility, and lower meibum quality compared to DED alone. Among these, higher upper eyelid pressure, lower partial blink rate, and worse grade of meibum expressibility were identified as risk factors for BEB in DED.

Meibomian Gland Dysfunction and Dropout in Diabetic Patients with Non-Proliferative Diabetic Retinopathy

This study aims to compare meibomian gland (MG) dropout and MG dysfunction (MGD) between patients with diabetes mellitus (DM) with moderate-severe non-proliferative diabetic retinopathy (NPDR) and patients with no diabetes (NDM). This prospective, transversal, age, and gender-matched case-control study included 98 DM and 106 NDM eyes. Dry eye disease (DED) and MGD evaluations were performed, including meibography (Keratograph 5M®). The objective MG dropout percentage was obtained by analyzing meibography images with ImageJ software (v. 1.52o, National Institutes of Health, Bethesda, MD, USA) and was subsequently graded with Arita's meiboscore. The DM duration was 18 ± 9 years. The mean meiboscore (3.8 ± 0.8 vs. 3.4 ± 1.0, p = 0.001), meiboscore severity (p = 0.016), and MG dropout (45.1 ± 0.1% vs. 39.0 ± 0.4%, p < 0.001) were greater in DM than in NDM. All patients showed MG dropout (meiboscore > 1). Lower eyelids showed greater MG dropout in both groups. A correlation with age (r = 0.178, p = 0.014) and no correlations with DM duration or gender (p > 0.005) were observed. Patients with diabetes showed greater corneal staining (1.7 ± 1.3 vs. 0.9 ± 1.1; p < 0.001), reduced corneal sensitivity (5.4 ± 1.1 vs. 5.9 ± 0.4; p < 0.001), lower MG expressibility (3. 9 ± 1.6 vs. 4.4 ± 2.1; p = 0.017), and worse meibum quality (1.9 ± 0.8 vs. 1.7 ± 0.5; p = 0.019). Tear breakup time, osmolarity, MMP-9, Schirmer, and the Ocular Surface Disease Index showed no significant differences. In conclusion, patients with DM with NPDR have greater MG dropout and meiboscore, as well as more severe MGD and DED parameters than persons with NDM.

Moderate-severe peripheral neuropathy in diabetes associated with an increased risk of dry eye disease

SIGNIFICANCE

This study establishes an increased risk of developing dry eye disease (DED) in patients with diabetic peripheral neuropathy using validated diagnostic criteria for both conditions.

PURPOSE

The disruption of ocular surface homeostasis has been associated with diabetes. However, it remains unclear if this association is independently influenced by peripheral neuropathy secondary to diabetes. This study aimed to investigate the clinical signs and symptoms of DED and their association with the severity of peripheral neuropathy in participants with type 2 diabetes.

METHODS

This prospective cross-sectional study recruited 63 participants with type 2 diabetes. All participants underwent a detailed assessment of DED using dry eye questionnaires (Ocular Surface Disease Index, Dry Eye Questionnaire-5), tear osmolarity, lipid layer thickness, noninvasive keratographic tear breakup time, phenol red thread test (PRT), and ocular surface staining. Corneal nerve morphology was imaged using corneal confocal microscopy. Based on the Total Neuropathy Scale, participants were stratified into no/mild (n = 48) and moderate/severe (n = 15) neuropathy groups.

RESULTS

Dry eye disease was diagnosed in 31 participants (50%) of the total cohort, and the odds of developing DED in the moderate/severe neuropathy group were four times (95% confidence interval, 1.10 to 13.80; p=0.030) higher compared with the no/mild neuropathy group. The Dry Eye Questionnaire-5 scores were significantly higher (p=0.020), and PRT values (p=0.048) and corneal nerve fiber length (p<0.001) were significantly reduced in the moderate/severe neuropathy group compared with the no/mild neuropathy group. In regression analysis, neuropathy scores were independently associated with PRT measurements ( β = -0.333, p=0.023) and nerve fiber length ( β = -0.219, p=0.012) while adjusting for age, gender, hemoglobin A 1c , and duration of diabetes.

CONCLUSIONS

Type 2 diabetic patients with peripheral neuropathy have a risk of developing DED, which increases with the severity of neuropathy. The observation that worsening peripheral neuropathy is associated with reduced tear secretion suggests that it may contribute to aqueous insufficiency.

Meibography signal intensity as a novel image biomarker for meibomian gland function: evidence from cross-sectional and longitudinal analyses

Background

Meibomian gland dysfunction (MGD), one of the most common ocular surface diseases, can induce dry eye and reduce patients' quality of life. Methodological limitations have resulted in contradictory interpretations of gland function. This study sought to investigate the correlation between meibography signal intensity (SI) and meibomian gland (MG) function and to validate an MGD classification strategy based on different levels of SI.

Methods

A multicenter, cross-sectional analysis was conducted on 817 eyes from 361 patients with MGD and 52 healthy controls. Additionally, 78 eyes from 39 patients with MGD who had undergone LipiFlow treatment were recruited for longitudinal analyses. The SI value was obtained via meibography using an automated analyzer, and all participants underwent ocular surface examinations. A cross-sectional analysis was performed to determine SI distribution and its relationship to clinical characteristics via a generalized estimating equation model. Longitudinal analyses were conducted on the treatment cohort using a mixed-effects model to explore the outcome in different SI levels.

Results

Regression analysis revealed significant correlations between SI and lipid layer thickness (β=0.016), meibum expressibility (β=-0.676), meibum quality (β=-0.251), and fluorescein-stained tear-film break-up time (FBUT) (β=0.064) (all P values <0.001 for the above associations). Low-level SI MGD cases exhibited the most severe clinical signs, including the worst meibum expressibility (16% for level 3) and quality scores (19% for level 3), the shortest FBUT (3.82±0.13 s), and the thinnest lipid layer (65.68±2.58 nm), (all P values <0.05, respectively). Patients with medium SI showed the lowest ocular surface disease index (OSDI) value (26.64±1.06), the longest FBUT (4.56±0.08 s), and the thickest lipid layer (80.20±2.90 nm). After treatment, the high SI values reduced significantly at each follow-up point compared to baseline (all P values <0.05). The medium SI group demonstrated the greatest improvement in symptoms and signs, followed by the high SI group, and the low SI group.

Conclusions

Automated measurements of SI can effectively reflect MG secretory activity. The proposed low, medium, and high SI classifications represent different functional subtypes of MGD.

Quantitative evaluation of morphological and functional changes in meibomian glands and lipid layer thickness in patients with and without keratoconus

PURPOSE

To quantitatively evaluate the morphological parameters of meibomian glands (MGs) and lipid layer thickness (LLT) in patients with keratoconus (KC).

METHODS

In this prospective, cross-sectional study, 164 eyes of 164 keratoconus patients and 64 eyes of 64 age-matched control subjects were included. An advanced automatic MG analyzer was used to quantitatively measure the morphological and functional parameters of MGs. Morphological and functional parameters of MGs, LLT, and other ocular surface parameters were compared between the control and KC groups.

RESULTS

The mean meibomian gland diameter, length, square, and gland area ratio (GA) were all significantly decreased in the KC group (all P < 0.05), while no significant difference was observed in the gland tortuosity index (TI) and gland signal index (SI) between the KC and control groups (all P > 0.05). There was no significant difference in the number of total and incomplete blinking among patients with different stages of keratoconus (all P > 0.05). The gland diameter, square, and TI were all negatively associated with KC severity (all P < 0.05), while no significant difference was observed among all stages of KC in gland length, GA, and SI (all P > 0.05). Moreover, the LLTs were positively correlated with the gland diameter, square, GA, and TI and negatively correlated with anterior corneal curvature or KC severity (all P < 0.05).

CONCLUSIONS

Atrophic morphological changes in the meibomian glands were closely correlated with the severity of keratoconus. Gland diameter may be a sensitive functional morphology metric of meibomian glands in patients with keratoconus.

Tear film assessment before and after phacoemulsification in patients with age-related cataracts

BACKGROUND

The study aims to assess the tear film before and after phacoemulsification in patients with age-related cataracts.

METHODS

A prospective observational study of 41 age-related cataract patients undergoing phacoemulsification procedure. Tear Film Break-Up Time (TBUT), Tear Film Meniscus Height (TMH), Meibomian glands (MG), and Lipid Layer Thickness (LLT) were assessed by a non-invasive Dry Eye Diagnostic System. All measurements were taken preoperatively, one week, one month, and three months postoperatively. The Marginal homogeneity and The Cochran Q tests were used in the statistical analysis.

RESULTS

The value of Non-Invasive Break-Up Time (NITBUT) was statistically significantly lower at one week (7.15 ± 3.31), one month (7.61 ± 3.41), and three months (7.66 ± 3.36) postoperatively than preoperatively (10.71 ± 2.71), p < 0.001. The Non- Invasive Tear Meniscus Height (NITMH) was significantly lower at one week (0.18 ± 0.0), one month (0.20 ± 0.09), and three months (0.20 ± 0.09) postoperatively than preoperatively (0.30 ± 0.113) p < 0.001. By the first month, both (NITBUT) and (NITMH) improved significantly compared to the first post-operative week. There was no statistically significant difference between one month and three months. The (NITMH) improved to a healthy level of ≥ 0.2 mm by the first month through the third month. Both (NITBUT) and (NITMH) did not reach the baseline by the third month. The meibomian glands and the lipid layer thickness had the same preoperative grade distribution without changes.

CONCLUSION

Phacoemulsification surgery can cause post-operative deterioration in the tear film, which starts within a week of the procedure, followed by gradual recovery over the next weeks and months. The phacoemulsification procedure mainly affects the tear break-up time and tear meniscus height. Both the lipid layer and meibomian glands are not affected.

Temporal variations in meibomian gland structure-A pilot study

PURPOSE

To investigate whether there is a measurable change in meibomian gland morphological characteristics over the course of a day (12 h) and over a month.

METHODS

The study enrolled 15 participants who attended a total of 11 study visits spanning a 5-week period. To assess diurnal changes in meibomian glands, seven visits were conducted on a single day, each 2 h apart. For monthly assessment, participants attended an additional visit at the same time of the day every week for three consecutive weeks. Meibography using the LipiView® II system was performed at each visit, and meibomian gland morphological parameters were calculated using custom semi-automated software. Specifically, six central glands were analysed for gland length ratio, gland width, gland area, gland intensity and gland tortuosity.

RESULTS

The average meibomian gland morphological metrics did not exhibit significant changes during the course of a day or over a month. Nonetheless, certain individual gland metrics demonstrated notable variation over time, both diurnally and monthly. Specifically, meibomian gland length ratio, area, width and tortuosity exhibited significant changes both diurnally and monthly when assessed on a gland-by-gland basis.

CONCLUSIONS

Meibomian glands demonstrated measurable structural change over short periods of time (hours and days). These results have implications for innovation in gland imaging and for developing precision monitoring of gland structure to assess meibomian gland health more accurately.

Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial

Importance

Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations.

Objectives

To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD.

Design, Setting, and Participants

This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily.

Interventions

rTG ω-3 Fatty acid supplementation vs grape-seed oil.

Main Outcome Measures

The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change.

Results

A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was -20.5 (16.0) and -22.7 (15.7), respectively, in the ω-3 group and -15.1 (20.2) and -18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = -5.4; 95% CI, -12.15 to 1.33; P = .12 and at 12 weeks = -3.9; 95% CI, -10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group.

Conclusions and Relevance

This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD.

Trial Registration

CRIS Identifier: KCT0004927.

Prevalence of meibomian gland dysfunction at a tertiary centre in Taiwan

CLINICAL RELEVANCE

Meibomian gland dysfunction and dry eye disease are closely related conditions that often coexist and can contribute to the development of each other. Understanding the similarities and differences between these diseases can assist clinicians in implementing effective treatments for both conditions in a clinical setting.

BACKGROUND

Dry eye disease is a multifactorial disease of the tears and ocular surface. This study aimed to evaluate the demographic characteristics of patients with meibomian gland dysfunction in Taiwan, investigate the association between meibomian gland dysfunction and dry eye parameters, and estimate the prevalence of meibomian gland dysfunction among patients with dry eye symptoms at a tertiary referral centre.

METHODS

This cross-sectional study enrolled patients aged ≥20 years who complained of dry eye symptoms and visited a tertiary centre between September 2019 and March 2020. The patients completed the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires before undergoing ocular examination. The lipid layer thickness and meiboscale scores were recorded. In addition, the study measured tear film break-up time, examined corneal staining, and evaluated the number of meibomian glands yielding liquid secretions using a slit lamp.

RESULTS

The study evaluated 202 eyes of 202 patients with a mean age of 58.05 ± 13.34 years. The prevalence of meibomian gland dysfunction was 93%. Mean meiboscale score and age were negatively associated, and tear film break-up time was positively associated with the mean number of meibomian glands yielding liquid secretions. Hyperlipidaemia and smoking were the main risk factors for Meibomian gland dysfunction.

CONCLUSIONS

The prevalence of meibomian gland dysfunction among patients with dry eye symptoms was extremely high at the tertiary centre, highlighting the strong relationship between Meibomian gland dysfunction and dry eye disease. Clinicians should consider meibomian gland dysfunction as a possible cause of dry eye.

Analysis of Factors Associated with Anterior Location of Marx's Line

PURPOSE

The study aimed to investigate the factors associated with anterior location of Marx's line in ocular surface and living habits, especially in tear film.

MATERIALS AND METHODS

This cross-sectional study enlisted 483 participants with meibomian gland dysfunction, who were divided into two groups: 160 participants with mild anterior location of Marx's line and 323 participants with moderate-to-severe anterior location. Participants completed a survey of demographic characteristics (sex, age, length of visual terminal use, sleep duration, skin property), and the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires. They also underwent slit-lamp examinations of the lids, and measurements of non-invasive tear break up time, tear meniscus height, fluorescein tear break up time, lipid layer thickness, partial blink rate, lid wiper epitheliopathy, and meibomian gland dropout.

RESULTS

The tear meniscus height (mild:0.21(0.18-0.25), moderate-to-severe:0.19(0.16-0.23), p = 0.004), fluorescein tear break up time(mild:3(2-4),moderate to severe:2(1-3), p = 0.000), max LLT(mild:87(62-100), moderate-to-severe:99(69-100), p = 0.04), average LLT(mild:64.5(47.5-96.75), moderate-to-severe:74(53-100), p = 0.012), min LLT(mild:52(38-75), moderate-to-severe:59(41-85), p = 0.029) differed significantly between mild and moderate-to-severe anterior location of Marx's line, and associated to the anterior location of Marx's line(r=-0.134, p = 0.03; r=-0.194, p = 0.000; r = 0.093, p = 0.041; r = 0.119, p = 0.009; r = 0.105, p = 0.022) However, no statistical significance was observed in the OSDI, SPEED, partial blink rate, non-invasive tear breakup time, lipid layer thickness, meibomian gland dropout and lid wiper epitheliopathy(p > 0.05). Meanwhile, in the demographic characteristics, statistically significant correlations were associated with skin property(r = 0.154, p = 0.001) and sleep duration(r=-0.124, p = 0.006), but not with age, sex, and the length of visual terminal use (p > 0.05).

CONCLUSIONS

Lower TMH and shorter TBUT positively correlated with anterior location of the Marx's line, and were risk factors. Meanwhile, participants with oily skin and shorter sleep duration were more likely to exhibit anterior location of Marx's line.

Prevalence of Dry Eye Disease in Laser-Assisted In Situ Keratomileusis Candidates

OBJECTIVE

To evaluate the prevalence of dry eye disease (DED) in laser-assisted in situ keratomileusis (LASIK) candidates.

METHODS

A chart review of consecutive LASIK candidates who underwent full ocular surface work-up was performed, including ocular surface disease index (OSDI), noninvasive tests (noninvasive tear breakup time [ni-TBUT], tear meniscus height, lipid layer thickness, and meibography), and invasive tests (Schirmer test I, fluorescein TBUT, corneal staining, and meibomian gland [MG] expressibility). The prevalence of DED was calculated according to the Dry Eye Workshop II (DEWS II), and Japanese and Asia Dry Eye Society (JDES/ADES) criteria.

RESULTS

In total, 135 patients (270 eyes) were evaluated. The mean age was 32.6±8.3 years, and 62.9% were women (n=85); 19 patients (15.4%) wore contact lenses, and 31 patients (23.8%) used artificial tears. The mean OSDI was 18.2±16.9, which was abnormal in 54.1% (n=62). Inferior lid MG dropout was the sign with the highest percentage of abnormal results (61.5%; n=83). There were no differences between men and women in any test except for ni-TBUT (6.3±0.3 and 7.2±0.2, respectively; P=0.002). Dry eye disease prevalence was 25.9% and 53.3%, according to JDES/ADES and DEWS II criteria, respectively. The only significant risk factor for DED was artificial tear use for both DEWS II (odds ratio [OR]=3.5, confidence interval [CI] [1.35-9.39]) and JDES/ADES (OR=2.58, CI [1.03-6.48]).

CONCLUSIONS

This study found a high prevalence of DED and abnormalities in LASIK candidates and highlights the importance of ocular surface evaluation before photorefractive surgery.

Evaluation of Meibomian gland structure and appearance after therapeutic Meibomian gland expression

CLINICAL RELEVANCE

Evaluating how Meibomian glands can change in appearance has the potential to advance the understanding of Meibomian gland health and may lead to enhanced diagnosis and therapy.

BACKGROUND

This work aimed to investigate Meibomian gland appearance after therapeutic Meibomian gland expression.

METHODS

Fifteen subjects attended three study visits over a two-week period. Meibography was performed before and after therapeutic Meibomian gland expression, the following day, and 2 weeks after expression. Six central glands were used to calculate Meibomian gland morphological parameters such as gland length ratio, gland width, gland area, gland tortuosity, and gland contrast. A custom semi-automated image analysis software was used to calculate Meibomian gland metrics. Furthermore, a high-resolution imaging system was developed to capture clear images of the Meibomian glands, free of any artefacts, which were used for precise calculations of Meibomian gland contrast.

RESULTS

The expression procedure had a significant impact on Meibomian gland contrast and length ratio immediately afterwards. The least square mean difference (95% CI) from baseline for Michelson contrast was -0.006 (-0.010, -0.001) and -1.048 (-2.063, -0.033) for simple contrast. The least square mean ratio of the gland length ratio immediately after the expression to baseline was 0.758 (0.618, 0.931).

CONCLUSIONS

Following therapeutic expression, Meibomian glands exhibit reduced brightness and length. However, within 24 h, they appear to recover and return to their baseline state, indicating a relatively short recovery time. This sheds light on whether meibography is solely focused on capturing gland structure or if it also captures acinar activity. The hyperreflective properties of lipids suggest that the decrease in contrast observed after expression could be attributed to a reduction in the visualisation of acini activity. A decrease in Meibomian gland length ratio implies that the loss of gland structure following treatment may be indicative of a temporary structural alteration.

The ILux® compared to the mechanical meibomian gland expression for the treatment of moderate and severe meibomian gland dysfunction

AIM

To compare the safety and effectiveness of eyelid treatment with the ILux®-MGD Treatment System in one session versus five sessions of mechanical meibomian gland expression (MMGE) in patients with moderate to severe meibomian gland dysfunction (MGD).

METHODS

A prospective, randomized, open-label, and controlled clinical trial that compared one session of the ILux® MGD Treatment System versus five sessions of MMGE in both eyes of 130 patients aged ≥18y with Ocular Surface Disease Index (OSDI) scores ≥13, total meibomian gland scores (MGS) of <15 in the lower eyelid of each eye, and non-invasive tear break-up time (NI-TBUT) <10s, who were randomized 1:1 to ILux® or MMGE.

RESULTS

The mean age was 58±17.49y. Baseline total MGS scores in both treatment groups were comparable. During follow-up, there were significant differences in total MGS and per sector with P<0.001. Multivariate analysis was performed using generalized estimating equations corresponding to the generalized linear model for repeated means to determine the treatment relationship with total MGS, NIBUT, and OSDI. There was a significant difference between ILux® and MMGE (P<0.001) at follow-up from the first to the twelfth month in MGS, NI-BUT, and OSDI scores. No adverse events were reported.

CONCLUSION

ILux® treatment compared to MMGE significantly improves symptoms and signs in patients with moderate to severe MGD for one year without adverse events.

Diamond Bur Microblepharoexfoliation Combined with Intense Pulse Light and Meibomian Gland Expression for Evaporative Dry Eye: A Short-term Controlled Clinical Trial

INTRODUCTION

To assess the efficacy and safety of the combination of microblepharoexfoliation (MBE), intense pulse light (IPL) and meibomian gland expression (MGX) for treatment of meibomian gland dysfunction (MGD).

METHODS

This was a prospective, parallel-control trial conducted from April 2022 to January 2023. Participants were assigned to receive either three sessions of MBE-IPL-MGX treatment and home-based therapy (treatment group) or home-based therapy alone (control group). Outcome measures were assessed at baseline and after 2-month follow-up.

RESULTS

Seventy eyes of 70 patients were enrolled. MBE-IPL-MGX treatment achieved better improvements than home-based therapy in ocular surface disease index (OSDI) and symptom assessment in dry eye (SANDE) scores, noninvasive tear film break-up time (NIBUT), lipid layer grade (LLG), loss area meibomian gland (LAMG) and meibomian gland yielding secretion score (MGYSS). The mean differences between the two groups were as follows: OSDI (- 11.23 ± 4.68 points, P < 0.001), SANDE (- 24.63 ± 13.41 points, P < 0.001), NIBUT (1.3 ± 1.57 s, P = 0.033), LLG (0.4 ± 0.04 points, P = 0.003), LAMG (- 2.85 ± 1.69%, P = 0.023) and MGYSS (7.5 ± 2.32 points, P < 0.001). In addition, the increment (Δ) of MGYSS after MBE-IPL-MGX treatment was significantly higher in MGD grades 2 and 3 (all P < 0.001).

CONCLUSIONS

MBE-IPL-MGX treatment is an effective and well-tolerated procedure that improves dry eye symptoms and signs as well as meibomian gland secretions in patients with MGD. In addition, this treatment is recommended for MGD grades 2 and 3.

Sex Differences in the Prevalence of Meibomian Gland Dysfunction: A Mini Review

PURPOSE

In this review, we aimed to investigate the literature on sex-specific prevalence of meibomian gland dysfunction (MGD) and to determine whether women or men are more at risk for MGD.

METHODS

A search was conducted on PubMed using the terms: (Sex OR Gender OR prevalence) AND (Meibomian gland).

RESULTS

Twenty-four relevant studies on MGD prevalence were identified, including 10 population-based and 14 hospital-based studies. Among the population-based studies, five studies reported higher rates among men, three studies found no differences, and one study observed higher rates among women. In the hospital-based studies, 10 studies reported no difference, two found higher rates among men, and one found higher among women. In the reviewed literature, there was a considerable variation between studies in terms of quality, sample size, age ranges, diagnostic criteria.

CONCLUSIONS

While most of the population-based studies suggest a higher prevalence among men, the majority of clinic-based studies show no significant difference. Further research with larger samples and standardized criteria is needed to determine whether men are indeed more susceptible to MGD.

Short-Term Efficacy of Ophthalmic Cyclosporine: A 0.1% Cationic Emulsion in Dry Eye Patients Assessed Under Controlled Environment

INTRODUCTION

To evaluate the short-term efficacy of cyclosporine A (CsA)-0.1% cationic emulsion (CE) in patients with dry eye disease (DED) and mitigation of the inflammatory flares triggered by desiccating stress environments.

METHODS

A single-center non-randomized clinical trial was performed at a tertiary care setting. Twenty patients with DED treated with CsA 0.1% CE were exposed to a normal controlled environment (NCE) (23 °C, 50% relative humidity) and an adverse controlled environment (ACE) (23 °C, 10% relative humidity, 0.43 m/s localized airflow) during baseline and the 1- and 3-month visits. Patients underwent the following evaluations: conjunctival hyperemia and staining, corneal fluorescein staining (CFS) using the Oxford and Cornea and Contact Lens Research Unit (CCLRU) scale, meibomian gland (MG) secretion quality, Dry Eye Questionnaire-5, Symptom Assessment in Dry Eye (SANDE II), and Change in Dry Eye Symptoms Questionnaire. Multivariate models were adjusted for statistical analysis.

RESULTS

Nineteen women and one man (mean age, 58.9 ± 12.3 years) completed the study. All symptom questionnaires, CFS, conjunctival hyperemia and staining, and MG secretion quality improved (p ≤ 0.003) with 1 month of treatment; improvements were maintained after 3 months (p ≤ 0.02), except for SANDE II (p ≥ 0.07). The CFS worsening (total CCLRU) after baseline ACE exposure (from 8.6 to 10.1) was higher, although not significant (p = 0.64), compared with 1 month (from 5.4 to 5.8) and 3 months (from 5.0 to 5.9) after treatment.

CONCLUSION

Topical CsA-0.1% CE improved DED signs and symptoms after 1 month of treatment under controlled environmental conditions. Future studies should confirm the benefit of CsA-0.1% CE in desiccating stress environments.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT04492878.

Meibum Lipidomic Analysis in Evaporative Dry Eye Subjects

Meibomian Glands (MG) are sebaceous glands responsible for the production of meibum, the main component of the Tear Film Lipid Layer (TFLL). The TFLL facilitates the spread of the tear film over the ocular surface, provides stability and reduces tear evaporation. Alterations in meibum composition lead to different ocular alterations like Meibomian Gland Dysfunction (MGD) and subsequent Evaporative Dry Eye (EDE). The aim of the present study was to investigate the composition and abundance of meibum lipids and their relationship with eyelid margin abnormalities, lipid layer patterns and MG status. The study utilizes a lipidomic approach to identify and quantify lipids in meibum samples using an Elute UHPLC system. This system considered all four dimensions (mass/charge, retention time, ion mobility and intensity) to provide the accurate identification of lipid species. Samples were categorized as healthy or low/no signs of alteration (group 1) or severe signs of alteration or EDE/MGD (group 2). The current investigation found differences in Variable Importance in Projection lipid abundance between both groups for the MGD signs studied. Changes in meibum composition occur and are related to higher scores in eyelid margin hyperaemia, eyelid margin irregularity, MG orifice plugging, MG loss and lipid layer pattern.

Efficacy of far infrared functional glasses in the treatment of meibomian gland dysfunction-related dry eye

Meibomian gland dysfunction (MGD)-related dry eye disease (DED) is a significant subtype of DED. In this research, we investigate the effectiveness of far infrared (FIR) functional glasses in the treatment of MGD-related DED. According to the TFO DEWS II diagnostic criteria, 61 eyes with MGD-related DED were included. All participants wore functional FIR glasses throughout the day for a period of 4 weeks and were followed up three times during the treatment. All subjects were followed up thoroughly in accordance with the DED clinical examination procedure. Ultimately, the treatment's impact was assessed. We found the Visual Analogue Scale and Ocular Surface Disease Index scores after FIR treatment were significantly lower than the baseline values (p < 0.05). Compared with the baseline, fluorescein tear breakup time and corneal fluorescein staining score after FIR treatment were significantly improved (p < 0.05). The eyelid margin signs, meibum quality, and meibomian gland expressibility after the 4-week treatment were significantly better than those at baseline (p < 0.05). We can see that wearing the FIR functional glasses significantly relieves the symptoms and signs of patients. We believe FIR therapy could be considered as a new method of MGD-related DED.

Thermal effect on eyelid and tear film after low-level light therapy and warm compress

CLINICAL RELEVANCE

The warming effect of low-level light therapy may contribute to its therapeutic mechanism which is beneficial for dry eye management.

BACKGROUND

Low-level light therapy is proposed to work via cellular photobiomodulation and a potential thermal effect in dry eye management. This study examined the change in eyelid temperature and tear film stability after low-level light therapy compared to warm compress.

METHODS

Participants with no to mild dry eye disease were randomised into control, warm compress, and low-level light therapy groups. The low-level light therapy group was treated with Eyelight mask (633 nm) for 15 minutes, the warm compress group with Bruder mask for 10 minutes, and the control group with an Eyelight mask having inactive LEDs for 15 minutes. Eyelid temperature was measured using the FLIR One® Pro thermal camera (Teledyne FLIR, Santa Barbara, CA, USA), and clinical measures of tear film stability were evaluated before and after treatment.

RESULTS

Thirty-five participants (mean age ± SD, 27.3 ± 4.3 years) completed the study. Eyelid temperatures for external upper, external lower, internal upper and internal lower eyelids were significantly greater in the low-level light therapy and warm compress groups immediately after treatment compared to the control group (all p < 0.001). No difference in temperature was observed between the low-level light therapy and warm compress groups at all time points (all p > 0.05). Tear film lipid layer thickness was significantly greater after treatment (mean (95% CI), 13.1 nm (5.3 to 21.0), p < 0.005) but not different between groups (p > 0.05).

CONCLUSION

A single treatment of low-level light therapy increased eyelid temperature immediately after treatment, but the increase was not significantly different from warm compress. This suggests that thermal effects may in part contribute to the therapeutic mechanism of low-level light therapy.

Expression of ATP-Binding Cassette Transporter A1 (ABCA1) in Eyelid Tissues and Meibomian Gland Epithelial Cells

Purpose

To validate the adenosine triphosphate (ATP)-binding cassette transporter A1 (ABCA1) expression and distribution in human eyelid tissues and meibomian gland epithelial cells.

Methods

Meibomian gland tissues from human eyelids were isolated by collagenase A digestion and cultured in defined keratinocyte serum-free medium (DKSFM). Infrared imaging was used to analyze the general morphology of meibomian glands. Hematoxylin and eosin (H&E) staining and Oil Red O staining were used to observe the morphological structure and lipid secretion in the human meibomian gland tissues. Quantitative real-time polymerase chain reaction, western blotting, and immunostaining were used to detect the mRNA and protein expression and cytolocalization of ABCA1 in the meibomian gland tissues and cultured cells.

Results

The degree of loss of human meibomian gland tissue was related to age. Meibomian gland lipid metabolism was also associated with age. Additionally, human meibomian gland tissues express ABCA1 mRNA and protein; glandular epithelial cells express more ABCA1 mRNA and protein than acinar cells, and their expression in acinar cells decreases with differentiation. Furthermore, the expression of ABCA1 was downregulated in abnormal meibomian gland tissues. ABCA1 was mainly localized on the cell membrane in primary human meibomian gland epithelial cells (pHMGECs), whereas it was localized in the cytoplasm of immortalized human meibomian gland epithelial cells (iHMGECs). The mRNA and protein levels of ABCA1 in pHMGECs were higher than those in iHMGECs.

Conclusions

Meibomian gland tissues of the human eyelid degenerate with age. ABCA1 expression in acinar cells decreases after differentiation and plays an important role in meibomian gland metabolism.

Ocular surface and meibomian gland evaluation in euthyroid Graves' ophthalmopathy

PURPOSE

Euthyroid Graves' ophthalmology (EGO) refers to the subgroup of thyroid eye disease patients with distinct clinical presentations. This study evaluated the ocular surface and meibomian gland changes in EGO patients.

METHODS

A cross-sectional study was conducted at The Chinese University of Hong Kong including 34 EGO patients and 34 age-and sex- matched healthy controls. Outcome measures include anterior segment examination, keratographic and meibographic imaging.

RESULTS

Between 34 EGO patients and 34 age and sex-matched healthy controls, EGO was associated with a higher ocular surface disease index (P < 0.01), higher severity of meibomian gland dropout (upper: P < 0.001, lower: P < 0.00001) and higher percentage of partial blinking (P = 0.0036). The worse affected eyes of the EGO patients were associated with corneal staining (P = 0.0019), eyelid telangiectasia (P = 0.0009), eyelid thickening (P = 0.0013), eyelid irregularity (P = 0.0054), meibomian gland plugging (P < 0.00001), expressibility (P < 0.00001), and meibum quality (P < 0.00001). When the two eyes of the same EGO patient were compared, the degree of meibomian gland dropout was higher among the worse affected eyes (upper: P < 0.00001, and lower: P < 0.00001). Tear meniscus height, lipid layer thickness, and noninvasive break-up time were comparable between the two eyes of EGO patients and also between EGO patients and healthy controls. TMH was positively correlated with the degree of exophthalmos (r = 0.383, P < 0.05).

CONCLUSION

EGO patients have more ocular surface complications and meibomian gland dropouts than healthy controls. Almost 60% of them had dry eye symptoms, but aqueous deficiency was not apparent. Further studies are warranted to clarify the mechanism of dry eye in EGO. (249 words).