Instability of tear film and loss of meibomian glands in patients with acne vulgaris / Instabilidade do filme lacrimal e perda de glândulas meibomianas em pacientes com acne vulgaris

ABSTRACT Purpose: In this prospective study, we compared ocular clinical variables in patients with acne vulgaris with those of healthy controls. These variables included tear film break-up time, meibomian gland dropout rate, and anterior chamber parameters. Methods: Our sample comprised 73 eyes from 73 patients with acne vulgaris and 67 eyes from 67 healthy controls. All participants underwent a non-invasive first tear film break-up time test and the average tear film break-up time was evaluated. Meibography was used to identify any meibomian gland dropout. The parameters of the cornea and anterior chamber were measured using Scheimpflug topography imaging. Finally, the ocular surface disease index questionnaire was administered to score each participant on their subjective experience of ocular complaints. Results: The noninvasive first tear film break-up time values of the acne vulgaris Group and the control Group were 4.7 ± 2.8 and 6.4 ± 3.5 sec, respectively. There was a significant difference between the groups (p=0.016). The number of eyes with tear break-up at any time during the measurement period was also significantly higher in the acne Group (p=0.018). In the acne vulgaris Group, the mean meibomian gland dropout rates were 33.21 ± 15.5% in the upper lids and 45.4 ± 14.5% in the lower lids. In the control group, these rates were 15.7 ± 6.9% and 21 ± 9.7% respectively. Dropout was significantly higher in the acne group for both the upper and lower lids (p=0.000). Conclusion: We found impaired tear stability in patients with acne vulgaris and a high rate of meibomian gland dropout. These glands play a key role in tear stability and their dropout is likely to result in evaporative dry eye. Measurement of the variables in this study allows objective diagnosis of this condition using a non-invasive, dye-free methodology, with minimum contact.

RESUMO Objetivo: Neste estudo prospectivo, pacientes com acne vulgaris e indivíduos saudáveis do grupo controle foram comparados em relação ao tempo de ruptura do filme lacrimal, taxa de abandono de glândulas meibomianas e parâmetros da câmara anterior, usando o tempo de ruptura do filme lacrimal topográfico não invasivo, meibografia não invasiva e fotografia de Scheimpflug, respectivamente. Métodos: Setenta e três olhos de 73 pacientes com acne vulgaris e 67 olhos de 67 indivíduos saudáveis foram incluídos. Todos os participantes submetidos ao primeiro tempo de ruptura do filme lacrimal não-invasivo e ao tempo médio de ruptura do filme lacrimal não-invasivo foram avaliados pelo uso do tempo de ruptura do filme lacrimal; perda de glândulas meibomianas foram avaliadas por meibografia; os parâmetros da córnea e da câmara anterior foram medidos por fotografia de Scheimpflug; e, finalmente, as queixas oculares subjetivas foram pontuadas com o uso do questionário do Indice de doenças de superfície ocular. Resultados: Os valores do tempo de ruptura do primeiro filme lacrimal não-invasivo do Grupo com acne vulgaris e do Grupo controle foram 4,7 ± 2,8 e 6,4 ± 3,5 segundos, respectivamente, refererindo-se a uma diferença significativa entre os valores dos grupos (p=0,016). Qualitativamente, o número de olhos com ruptura lacrimal a qualquer momento durante o período de medição foi significativamente maior no grupo de pacientes. (p=0,018). No Grupo com acne vulgaris, a perda de glândulas meibomianas nas pálpebras superiores foi de 33,21 ± 15,5% e nas pálpebras inferiores foi de 45,4 ± 14,5%; por outro lado, no Grupo controle foi de 15,7 ± 6,9% e 21 ± 9,7% respectivamente; ambos os casos referem-se a uma diferença significativa entre os grupos (p=0,000). Conclusão: Encontramos estabilidade comprometida do filme lacrimal em pacientes com acne vulgaris. No entanto, o comprometimento foi de grau muito menor, em comparação com a taxa de perda das glândulas meibomianas que desempenham um papel fundamental na estabilidade do filme lacrimal. Esta condição pode ser documentada de forma objetiva - uma metodologia parcialmente sem contato, totalmente não-invasiva e livre de corantes.

Evaluation of Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum

ABSTRACT Purpose: To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. Methods: This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. Results: A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. Conclusion: In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.

Functional and morphological evaluation of the meibomian glands and ocular surface assessment at high altitude

Purpose: To compare the function and morphology of the meibomian glands and the ocular surface of individuals from highland and lowland. Methods: This was a randomized controlled trial. The study was performed with 104 individuals (51 individuals from the highland and 53 individuals from the lowland). Detailed eye examinations comprising tear meniscus height, lipid layer grading, non?invasive Keratograph tear breakup time (NIKBUT), and scoring of the meibomian glands from the upper and lower eyelids of the individuals were performed by Keratograph 5M (OCULUS, Wetzlar, Germany). Symptoms related to dry eye disease were assessed using the Ocular Surface Disease Index (OSDI). Results: In the highland group, tear meniscus height was lower (P = 0.024), lipid layer grade, as well as all the meiboscores were higher (P < 0.05) than that in the lowland group. The OSDI (P = 0.018) and the percentage of dry eye disease were also higher as compared to that of the lowland group (P = 0.032). The first NIKBUT and average NIKBUT did not differ significantly between groups. The frequency of plugged meibomian gland orifices was greater in the lowland group compared to the highland group (P = 0.036). Conclusion: It was observed that dry eye disease was more common in the highland group. The morphological changes of meibomian gland dropout were significant in highlanders as demonstrated objectively with Keratograph 5M. Our study may raise a concern for environmental influences on ocular surface changes

Effects of wearing orthokeratology lens on ocular surface and meibomian gland in children and adolescents of different ages / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of orthokeratology lens on ocular surface and meibomian gland in children and adolescents of different ages.METHODS: A total of 120 cases(240 eyes)of myopic children and adolescents treated in the optometry clinic of our hospital from December 2020 to February 2021 were retrospectively selected, and they were divided into the orthokeratology group(60 cases, 120 eyes)and the frame glasses group(60 cases, 120 eyes)according to the myopia correction methods. The changes in ocular surface and meibomian gland after wearing glasses were analyzed, and those changes in patients of different ages were compared between the two groups.RESULTS: Corneal curvature decreased, non-invasive tear film break-up time(NIBUT)shortened and meibomian gland score increased at 3, 6, 9 and 12mo in the orthokeratology group after wearing lens, while lower tear meniscus height increased at 6, 9 and 12mo compared with that before wearing lens. In the frame glasses group, the lower tear meniscus height was higher at 6 and 9mo than that before wearing glasses(both P&#x003C;0.05). At the same time point, the corneal curvature of the orthokeratology group was significantly lower than that of the frame glasses group at all time points, the NIBUT at 3, 9 and 12mo after wearing the lens was shorter than that of the frame glasses group and the meibomian gland scores were higher at 6, 9 and 12mo than those at the same time point in the glasses group(all P&#x003C;0.05). After wearing lens for 12mo, the corneal curvature of the orthokeratology group at all ages was significantly lower than that of the frame glasses group, the NIBUT of the orthokeratology group at 8 to 12 years old and 13 to 15 years old was significantly lower than that of the frame glasses group, and the meibomian gland score was significantly higher than that of the frame glasses group(all P&#x003C;0.05).CONCLUSION: Orthokeratology lens may affect the ocular surface and meibomian glands function, and the effects on ocular surface are more pronounced in children and adolescents under 12 years old. Therefore, younger children and adolescents could be prioritized for myopia correction with framed glasses, and then wearing orthokeratology lens when they get older.

Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers / Avaliação da superfície ocular e das alterações morfológicas nas glândulas meibomianas através de meibografia sem contato em usuários de cigarros eletrônicos

ABSTRACT Purpose: The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers. Methods: The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases. Results: The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively). Conclusion: Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-ci­garette smoking.

RESUMO Objetivo: Avaliar a superfície ocular e a morfologia da glândula meibomiana em usuários de cigarros eletrônicos. Métodos: Foram avaliadas através de meibografia Sirius as pálpebras superiores e inferiores de 25 usuários de cigarros eletrônicos do sexo masculino e 25 pacientes não usuários saudáveis, também do sexo masculino. A perda nas glândulas meibomianas foi calculada automaticamente com o módulo de software de imagem de meibografia Phoenix. O resultado foi obtido como perda percentual. O questionário Ocular Surface Disease Index (OSDI), o teste do tempo de ruptura lacrimal e o teste de Schirmer II foram administrados em todos os casos. Resultados: A duração média do uso de cigarros eletrônicos foi de 4,9 ± 0,9 anos (intervalo de 3,4-7 anos). O valor médio do teste de Schirmer II foi de 9,16 ± 2,09 mm no grupo de usuários de cigarros eletrônicos e de 11,20 ± 2,14 mm no grupo controle (p=0,003). O valor médio do teste do tempo de ruptura lacrimal foi de 6,96 ± 2,31 segundos no grupo de usuários de cigarros eletrônicos e 9,84 ± 2,13 segundos no grupo controle (p=0,002). O valor médio do Ocular Surface Disease Index foi de 28,60 ± 6,54 e 15,16 ± 7,23 para os grupos de usuários de cigarros eletrônicos e controle, respectivamente (p<0,001). Na meibografia de Sirius, a perda média para a pálpebra superior foi de 23,08 ± 6,55% para o grupo de usuários de cigarros eletrônicos e 17,60 ± 4,94% para o grupo controle (p=0,002), e a perda média para a pálpebra inferior foi de 27,84 ± 5,98% e 18,44 ± 5,91%, respectivamente (p<0,001). Além disso, foi observada uma correlação positiva significativa entre a taxa de perda na meibografia palpebral superior e inferior com a duração do tabagismo eletrônico, respectivamente de (r=0,348, p<0,013) e (r=0,550, p<0,001). Conclusão: O uso prolongado de cigarros eletrônicos causa danos às glândulas meibomianas. Portanto, esses danos devem ser considerados em distúrbios da superfície ocular devidos ao uso desses dispositivos.

Noninvasive ocular surface analyzer as an adjunct in diagnosis and estimating prevalence of meibomian gland dysfunction: Hospital-based comparative study

Purpose: To assess the role of noninvasive ocular surface analyzer (OSA) in workup of meibomian gland dysfunction (MGD) and to estimate hospital?based prevalence of MGD using this objective device. Methods: The study recruited 113 consecutive participants attending the ophthalmology outpatient department of a tertiary care hospital. All participants were administered a symptom questionnaire. Participants underwent a comprehensive ocular examination, including slit?lamp biomicroscopy and meibomian gland expression. Lipid layer thickness (LLT), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and meibomian gland loss (MGL) were assessed using OSA. The presence of either or both reduced/absent meibum secretion and cloudy to toothpaste?like secretion was diagnosed as MGD. Results: Prevalence of total MGD was 57.52% (95% confidence interval [95% CI]: 48.3%–66.8%) and that of symptomatic MGD was 42.5% (95% CI: 33.2%–51.7%). Prevalence of total and symptomatic MGD was highest in those aged ?50 years (P < 0.001 and P = 0.004, respectively). Computer vision syndrome increased the odds of symptomatic MGD (odds ratio [OR]: 4.3). NIBUT and MGL significantly differed in MGD and non?MGD groups (P = 0.023 and P < 0.001, respectively). LLT significantly differed between asymptomatic and symptomatic cases (P = 0.033). MGL >25% increased the odds of having MGD (OR: 19.1). Significant negative correlations were observed between MGL and NIBUT (P = 0.04) and between MGL and LLT (P = 0.02). MGL demonstrated the highest diagnostic accuracy for MGD (AUC = 0.827, sensitivity = 75.4%, specificity = 85.4%, cut?off value: ?26%). Conclusion: MGD is a common disorder in adults attending the ophthalmology outpatient services of a tertiary eye care hospital. Incorporating noninvasive OSA in clinical practice can aid in rapid and reliable measurements of MGD?related parameters

Evaluation of visual quality parameters changes in patients with meibornian gland dysfunction and aqueous deficient dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze ocular wavefront aberrations and scattering parameters changes in patients with meibornian gland dysfunction(MGD)and aqueous deficient dry eye(ADDE), and assess the visual quality of patients with two types of dry eye syndromes.METHODS:There were 25 patients with MGD, 25 patients with ADDE and 25 healthy controls treated in our hospital from January to October 2018 were included in this study. Ocular surface disease index questionnaire(OSDI)and tear film correlation examination were performed in three groups. The tear film correlation examination included tear break-up time(TBUT), Schirmer test( SⅠt )and cornea fluorescein staining(FL). The root mean square of total high order aberration(HO), comatic aberration(CA), trefoil aberration(TA)and spherical aberration(SA)were recorded with i-Trace visual function analyzer. The scattering values were recorded by the double-pass Optical Quality Analysis System(OQAS Ⅱ), including the modulation transfer function(MTF cutoff ), Strehl ratio(SR)and objective scattering index( OSI ). Three groups of subjects kept their eyes open for 20s, the mean value of OSI was recorded using OQAS Ⅱ tear film analysis program.RESULTS:The OSDI score in MGD group was significantly higher than that in ADDE group(38.2±5.6 <i>vs</i> 32.2±7.2, <i>P</i><0.01). The SⅠT score in ADDE group was significantly lower than that in MGD group(1.98±0.92 <i>vs</i> 12.52±6.80mm/5min, <i>P</i><0.001). The TBUT and FL staining score were lower in MGD group than those in ADDE group(TBUT: 3.27±1.91 <i>vs</i> 6.02±1.05s, FL:3.27±2.18 <i>vs</i> 6.23±2.19, all <i>P</i><0.001). There was no significant difference in HO, CA, TA and SA between MGD Group and ADDE group(HO: 0.385±0.081 <i>vs</i> 0.344±0.092, CA:0.210±0.062 <i>vs</i> 0.175±0.075, TA:0.107±0.056 <i>vs</i> 0.086±0.042, SA:0.322±0.078 <i>vs</i> 0.273±0.097, HO:<i>t</i>=1.67, <i>P</i>>0.05; CA: <i>t</i>=1.80, <i>P</i>>0.05; TA: <i>t</i>=1.50, <i>P</i>>0.05; SA: <i>t</i>=1.97, <i>P</i>>0.05). There was no statistically significant differences between MGD group and ADDE group with the value of MTF cutoff, SR and OSI(MTF cutoff: 33.28±8.28 <i>vs</i> 37.12±9.53, SR: 0.19±0.06 <i>vs</i> 0.22±0.08, OSI:1.30±0.32 <i>vs</i> 1.12±0.52, MTF cutoff: <i>t</i>=1.52, <i>P</i>>0.05; SR: <i>t</i>=1.50, <i>P</i>>0.05; OSI: <i>t</i>=1.47, <i>P</i> >0.05). In the condition of not blinking, the mean value of OSI in MGD group was significantly higher than that in ADDE group(2.386±0.118 <i>vs</i> 1.554±0.058, <i>P</i><0.001).CONCLUSION:In the treatment of symptoms of patients with dry eye, improving the visual quality of patients should also be considered. The visual quality in patients with MGD is more serious than those with ADDE. The OSI related parameters seem to be sensitive indicators indexes to evaluate the dynamic changes of tear film-related visual quality in dry eye patients.

Night-wearing orthokeratology on adolescent ocular surface function / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effect of ocular surface and meibomian gland dysfunction of adolescents before and after wearing overnight orthokeratology, and to explore its effects on adolescent tear film. <p>METHODS: A prospective clinical study was conducted. 55 cases of 8 to 16-year-old adolescents who met the selection criteria from January 2017 to November 2017 were selected for orthokeratology. Before lens wear and after lens wear 1wk, 1mo, 3mo, 6mo, and 12mo were followed up for Ocular Surface Disease Index(OSDI)questionnaire, slit-lamp examination, and Keratograph 5M.<p>RESULTS: During the study period, no patients developed infectious keratitis. The OSDI scores were 7.38±1.71 points, 9.21±1.39 points, 10.19±1.02 points, 10.28±1.18 points, 10.29±1.85 points after wearing at 1wk, 1, 3, 6, and 12mo respectively, which were higher than those before wearing(4.80±1.63 points)were increased, and the difference was statistically significant at different times before and after wearing(<i>P</i><0.05). 1wk, 1, 3, 6, 12mo NIBUT(f)values were 12.39±4.76s, 9.95±5.23s, 11.30±4.58s, 11.21±4.34s, 11.63±5.32s, and NIBUT(av)values were respectively 11.26±6.77s, 11.16±6.48s, 13.09±5.79s, 13.13±5.41s, 13.19±5.21s, NIBUT(f)1mo after wearing compared with before wearing, the difference was statistically significant(<i>P</i><0.05), NIBUT(av)at 1wk and 1mo after wearing was compared with before wearing, the difference was statistically significant(all <i>P</i><0.05), and the difference was both at 3, 6, 12mo after wearing and before wearing No statistical significance(all <i>P</i>>0.05).There was no significant change in TMH at 1wk, 1, 3, 6, 12mo after wearing, and the difference was not statistically significant(<i>F</i>=2.168, <i>P</i>>0.05). Corneal fluorescein staining scores were 3.51±1.67 points, 3.54±1.62 points, 4.05±1.52 points, 4.14±1.32 points, 4.50±1.43 points, respectively, 1wk after wearing, 1, 3, 6, and 12mo, which were higher than those before wearing(<i>P</i><0.05). The meibomian gland lipid secretion score and the meibomian gland loss score did not change significantly at different times before and after wearing(<i>P</i>>0.05).<p>CONCLUSION: The tear film function in the early period of wearing the orthokeratology is reduced, but it gradually returns to the level before wearing the lens after 6mo, and tends to increase steadily. After wearing the orthokerato-scope, the symptoms of eye discomfort increase and corneal fluorescein stain increased after wearing, no effect on meibomian gland function.

Severe Ocular Surface abnormalities in a child and Ectodermal Dysplasia: A Case Report.

Ectodermal Dysplasia is a disorder that occurs due to abnormal development of at least two major ectodermal derivatives in the developing embryo. Author report the case of a 10 year old male child who was referred to our department with complaints of absent sweating, foreign body sensation and watering in both eyes for past few months. The family history could be traced to four generations and there was an observed trend of increase in severity of signs and symptoms occurring at younger age.  The purpose of this case report is to create awareness in the Ophthalmic community about the diagnosis and clinical manifestations of the disorder. This case highlights the role of multidisciplinary approach for management of systemic disease, genetic evolution of affected individual and carriers and genetic counseling.

Degeneración nodular de Salzmann en paciente mujer de 20 años de edad: un reporte de caso / Salzmann's nodular degeneration in a 20-year old female patient: case report

La degeneración nodular de Salzmann es un trastorno corneal no inflamatorio, infrecuente, de mayor prevalencia en mujeres mayores de 50 años. Se caracteriza por la presencia de nódulos blanquecinos en la córnea y está asociada a diversas patologías. Reportamos el caso de una paciente de 20 años con historia de astigmatismo, miopía y síndrome de ovario poliquístico. Acudió a consulta por presentar sensación de cuerpo extraño en el ojo izquierdo y negó el haber padecido infección o trauma ocular recientes. Al examen oftalmológico se evidenció disfunción de las glándulas de Meibomio y nódulos opacos en la periferia de ambas córneas. Los hallazgos clínicos y la tomografía de coherencia óptica confirmaron el diagnóstico de degeneración nodular de Salzmann. El tratamiento con ciclosporina tópica demostró ser efectivo en la disminución de la inflamación causada por la disfunción de las glándulas de Meibomio, lo que evitó recurrencias nodulares a corto plazo.

Salzmann's nodular degeneration is an uncommon non-inflammatory corneal disorder, which is more prevalent in women more than 50 years old. It is characterized by the presence of whitish nodules in the cornea and it is associated to certain conditions. We report the case of a 20-year old female patient with past history of astigmatism, myopia, and polycystic ovary syndrome. She presented reporting a foreign body sensation in her left eye and she denied having had recent eye infection or trauma. The ophthalmological examination revealed Meibomian gland dysfunction and opaque nodules in the periphery of both corneas. Clinical findings and an optical coherence tomography (OCT) corroborated the diagnosis of Salzmann's nodular degeneration. Therapy using topical cyclosporin proved to be effective in reducing the inflammation caused by Meibomian gland dysfunction, which prevented nodular recurrence in the short term.

Distribution and Characteristics of Meibomian Gland Dysfunction Subtypes: A Multicenter Study in South Korea

PURPOSE: We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea. METHODS: One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded. RESULTS: The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, p < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid. CONCLUSIONS: The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.

Effects of Preservative on the Meibomian Gland in Glaucoma Patients Treated with Prostaglandin Analogues / 전남의대학술지

This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.

Demodex in eyelash follicles in patients with Meibomian gland dysfunction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the prevalence and clinical effects of the comprehensive treatment of demodex in eyelash follicles in patients with Meibomian gland dysfunction(MGD). <p>METHODS: This study was a prospective analysis.The MGD patients(experimental group, 264 eyes in 132 patients)and normal subjects(control group, 192 eyes in 96 patients)were collected from the He Eye Hospital from January 2016 to July 2017. Comprehensive treatment of patients in the experimental group. Eyelash sampling, demodex counting, tear film break up time(BUT), cornea fluorescein staining(FL)and Schirmer Ⅰ test(SⅠt)were measured for both groups. The symptom score of MGD patients was recorded.<p>RESULTS: For the experimental and control groups, the number of demodex before the treatment was 7(6, 9)and 2(1, 3), respectively(<i>Z</i>=5.264, <i>P</i><0.01). The percentage of demodex infestation was 100% and 28.1%,respectively(χ²=35.957, <i>P</i><0.01). The BUT was 4.06±1.38 and 12.00±2.82s. The FL was 3.06±1.57 and 0.46±0.63. The SⅠt was 6.93±2.08mm and 11.13±2.38mm/5min, respectively(<i>t</i>=-9.825, <i>t</i>=5.978, <i>t</i>=-4.776; all <i>P</i><0.01). The symptom score of the MGD group before and after treatment was 6.57±2.93 and 3.27±1.89, respectively(<i>t</i>=5.443, <i>P</i><0.01). After the treatment, the percentage of demodex infestation of the experimental group were 57.6%, the number of demodex were 3(0-5), had significant difference with the data before the treatment(<i>Z</i>=3.937, <i>P</i><0.01). The BUT and FL were 6.53±3.27s and 1.67±0.54, and all had significant difference with the data before the treatment(<i>t</i>=5.152, 4.328; all <i>P</i><0.01). The SⅠt of the experimental group after the treatment was 8.37±5.34mm/5min, with no significant difference with the data before the treatment(<i>t</i>=-0.285, <i>P</i>=0.748).<p>CONCLUSION: Demodex infection can cause Meibomian gland dysfunction and produce corresponding clinical symptoms. The comprehensive treatment can greatly diminishes the number of demodex mites and effectively relieve the symptoms of Meibomian gland dysfunction which is associated with demodex infestation.

Meibomian Gland Dysfunction as an Indicator of Hypercholesterolemia: A Case Control Study

Background: Chemical analysis of lipids secreted from meibomian glands shows that it consists of a mixture of non-polar and polar lipids. Systemic dyslipidemia may theoretically affect the meibomian lipid composition and secretion. The purpose of this study was to investigate a possible correlation between Meibomian gland dysfunction (MGD) and hypercholesterolemia and that MGD may become a marker of previously unknown hypercholesterolemia. Methods: After obtaining approval of the Institutional Ethics Committee, a case control study was undertaken in the Department of Ophthalmology, AJ Institute of Medical Sciences and Hospital from August 2016 till January 2017 enrolling 60 MGD cases and 100 controls. Patients satisfying inclusion and exclusion criteria were enrolled and examined using pre-specified clinical criteria. Using statistical analysis serum lipid profile was compared for cases and controls.Results: 60 cases of MGD and 100 controls with average age 48.03±12.05 and 44.61±12.11 years respectively were enrolled. Higher serum triglyceride levels were seen in cases (144.03±55.54 mg/dL) and so were higher low density lipid levels (122.16±39.41 mg/dL). MGD cases had higher levels of high density lipids (42.36±13.16 mg/dL) and controls had 41.38±12.17. Using Fisher’s exact test, gender of the subjects was found to be statistically significant for MGD development (p=0.006). Distribution of serum cholesterol and low density lipids was found to be statistically different across the different categories of MGD; p=0.006 and p=0.037 respectively. Conclusion: This study suggests that MGD can act as a clinical marker for hypercholesterolemia. Larger, multi-centric studies are required to confirm our findings

Research progress on ocular rosacea / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular rosacea is a chronic inflammatory disease that affects the ocular surface. The clinical manifestations are blepharitis and Meibomian gland dysfunction, severe corneal involvement and visual impairment. The study of the pathogenesis in recent years is believed to be the result of a combination of risk factors. Its clinical manifestations lack specificity, but early diagnosis and standard treatment can significantly improve symptoms and restore vision. This review focuses on the latest research progress in ocular rosacea.

Analysis of meibomain gland change and ocular surface condition in age-related cataract population / 中华实验眼科杂志

Background Meibomain gland is a specially differentiated sebaceous gland lying in the tarsus of upper and lower eyelid.The morphological changes of the gland is associated with a variety of ocular surface diseases.Studying the relationship of morphological and functional change of meibomain gland with ocular surface is of great significance.Objective This study was to observe the change of morphology,structure and function of meibomain gland over aging and investigate the assocation of meibomain gland abnormality with ocular surface.Methods A prospectively cases-observational study was performed.Ninety-three eyes of 93 patients with age-related cataract aged 45 and older were enrolled in Shanxi Eye Hospital from March to September 2016 under the informed consent.The patients were divided into 45 to 59-year group and ≥60-year group according to age or meibomian gland loss ≥ 1/3 group and meibomian gland loss ＜ 1/3 group.The ocular anterior segment,lid margin,meibomian gland orifices and lipids traits were examined by slit-lamp microscope.The ocular surface symptoms were assessed and scored by Ocular Surface Disease Index (OSDI) scale.The break-up time of tear film (BUT),tear meniscus height,meibomian gland dropout degree,conjunctival hyperemia and corneal fluorescence staining scores were measured using ocular surface analyzer.Results No dry eye symptom was complained in all the subjects,and their OSDI scores were ＜12.No abnormal changes at the lid margin and the muco-cutaneous junction were observed.No abnormality of the meibomian gland orifices,the lipids traits and drainage was observed under the slit-lamp microscope.BUT was shortened in 42 eyes (45.16％);tear meniscus height was lowed in 52 eyes (55.91％);meibomian gland loss range was ≥1/3 in 58 eyes (62.27％).The meibomian gland loss scores were 1.65±0.79 in the 45 to 59-year group and 1.86±0.72 in the ≥60-year group,showing an insignificant difference between them (t =1.301,P =0.197).But when coming to the correlation analysis,a positive correlation was found between meibomian gland loss scores and age (rs =0.323,P=0.002),and no correlations were seen between age and BUT or tear meniscus height (rs =0.154,P =0.141;rs=-0.024,P =0.821).In addition,meibomian gland loss scores showed a negative correlation with mean BUT (rs =-0.251,P =0.015).The eye number of BUT abnormality in the meibomian gland loss ≥ 1/3 group was more than that in meibomian gland loss ＜1/3 group (P =0.018).Conclusions Meibomian gland loss is more serious over aging in middle aged and elderly population,and serious meibomian gland loss increases the risk of tear film instability.The early meibomain gland dysfunction-like signs occur prior to symptoms,which should raise concern in clinical work.

Effects on Ocular Surface and Compliance of Orthokeratology Wear in Adults with Contact Lens Discomfort

PURPOSE: To evaluate the effects on the ocular surface and the compliance of overnight orthokeratology lenses wear in normal myopic adults experiencing contact lens discomfort. METHODS: In this study, 28 eyes of 14 subjects were analyzed using overnight orthokeratology (OOK). This prospective study investigated the compliance of OOK wear using questionnaires, spherical equivalents, keratometry, and central corneal thickness. Ocular surface disease index, tear osmolarity, Schirmer's test I, tear film break-up time, and ocular surface staining score were evaluated as ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality and meiboscore using noncontact meibography. The tests were performed before and 1 and 6 weeks after OOK wear. RESULTS: The mean age of the subjects was 26.67 ± 3.26 years, and the average duration of previous contact lens use was 2.64 ± 2.41 years. The questionnaire results showed that OOK lenses were more comfortable to wear than conventional lenses. Significant changes in spherical equivalents, keratometry, and central corneal thickness were observed at 6 weeks compared with baseline values (all p 0.05). CONCLUSIONS: Based on the findings, OOK is a relatively safe modality with good compliance for normal myopic adults experiencing contact lens discomfort.

Conceptos actuales en la disfunción de las glándulas de meibomio / Current concepts about the meibomian gland dysfunction

Los científicos han estado interesados en el estudio de las secreciones de las glándulas de Meibomio desde hace muchos años. Enfermedades asociadas, como los cánceres y la blefaritis posterior, se han observado en la literatura médica, desde la primera parte del siglo XX. Sin embargo, el término "disfunción de las glándulas de Meibomio" fue introducida por Korb y Henríquez en 1980. No existía una definición establecida publicada en la literatura hasta que más de 50 expertos internacionales participaron en un taller, que tuvo lugar durante un período de dos años, donde se llegó a definir como una anormalidad crónica y difusa de estas glándulas, comúnmente caracterizada por la obstrucción del conducto terminal y cambios cualitativos/cuantitativos en la secreción de esta. Esto puede resultar en la alteración de la película lagrimal, síntomas de irritación ocular, inflamación clínicamente aparente y enfermedad de la superficie ocular. Es en el mismo Taller Internacional, donde se decide clasificar de acuerdo con los cambios anatómicos, fisiopatológicos, o la gravedad de la enfermedad, donde la forma obstructiva fue la más generalizada. Constituye una afección frecuente con disminución de la calidad de vida y perjuicios potencialmente graves para el bienestar humano.

Scientists have been interested in the study of secretions from meibomian glands for many years. Related illnesses as cancer and posterior blepharitis have been found in the medical literature since the first half of the 20th century. However, the term «meibomian gland dysfunction¼ was introduced by Korb and Henríquez in 1980. There was not a set definition published in the literature until over 50 international experts participated in a workshop held for 2 years. It was there where this disorder was finally defined as a chronic diffuse anomaly occurred in these glands, which is generally characterized by obstructed terminal duct and qualitative/quantitative changes in the gland secretion. This may cause altered lachrymal film, ocular irritation symptoms, clinically apparent inflammation and ocular surface disease. In the same international workshop, it was decided to classify meibomian gland dysfunction according to the anatomical, physiopathological changes or to the severity of the disease, being the obstructive type the most generalized form. This is a frequent illness that reduces the quality of life and causes potentially serious damages for the human wellbeing.

Carcinoma de glándulas sebáceas palpebrales / Carcinoma of palpebral sebaceous glands

El carcinoma de glándulas sebáceas es un tumor altamente maligno y potencialmente letal. Puede enmascarar enfermedades inflamatorias como blefaritis, blefaroconjuntivitis, meibomitis, tarsitis y chalazión recurrente. Por eso, ante la presencia de una lesión palpebral de presentación atípica o recidivante se impone una exéresis completa con margen oncológico para su estudio anatomopatológico. Esta afección cursa con un diagnóstico clínico difícil, y en ocasiones inadvertido, por lo que se realizó una revisión bibliográfica para profundizar en sus diferentes formas de presentación, pronóstico y tratamiento.

The sebaceous gland carcinoma is a highly malignant tumor and potentially lethal; it may masquerade inflammatory diseases such as blepharitis, blepharoconjunctivitis, meibomitis, tarsitis and recurrent chalazion. Hence, the presence of palpebral injury of recurrent or atypical presentation imposes a complete resection with oncological margin for pathological examination. This condition presents with difficult clinical diagnosis and sometimes unnoticed, so we conducted a literature review to delve into its various forms of presentation, prognosis and treatment.

Efficacy of meibomian gland compression and meibomian gland dredge treatment with dry eye young patients of meibomian gland dysfunction / 中国医师进修杂志

Objective To understand the efficacy of meibomian gland compression by themselves and outpatient meibomian gland dredge treatment with dry eye young patients of meibomian gland dysfunction.Methods Selected 48 young patients with dry eye of meibomian gland dysfunction,patients were divided into two groups according to the wishes,28 patients were given method guidance of meibomian gland compression by themselves (compression group),every 10 minutes,three times a day,4 weeks after the referral.Other 20 cases meibomian gland dredge by a doctor at the eye clinic performed under anesthesia (dredge group),2 weeks,4 weeks after the referral and then dredge,3 times.All patients were given to health education,all patients before treatment and after treatment for 4 weeks underwent Schirmer Ⅰ test (S Ⅰ t),tear film breakup time (BUT),corneal fluorescein staining (CFL) examination and compared.Results The level of BUT,S Ⅰ t,CFL before treatment in two groups had no significant difference (P ＞ 0.05).After treatment for 4 weeks,eye symptom had improved in two groups.The level of BUT,CFL before and after treatment for 4 weeks in two groups had significant difference (P ＜ 0.05).But the level of S Ⅰ t,BUT,CFL after treatment for 4 weeks between two groups had no significant difference (P ＞ 0.05).Conclusion Dry eye young patients of meibomian gland dysfunction if they can correctly perform meibomian gland compression by themselves can also be reached effectively alleviate dry eye and ocular discomfort symptom improvement purposes.