A novel noninvasive ocular surface analyzer for the assessment of dry eye with Meibomian gland dysfunction

Abstract Purpose To compare the levels of inflammatory molecules in tear samples between patients with meibomian gland dysfunction (MGD)-related evaporative dry eye (EDE) and healthy subjects and to analyze the correlations between the levels of tear inflammatory molecules and ocular surface parameters. Methods A total of 30 MGD-related EDE patients (48 eyes) and ten healthy volunteers (15 eyes) were enrolled. Dry eye-related examinations and questionnaires were obtained from all participants. The levels of nine inflammatory molecules were determined through multiplex bead analysis. Results Inflammatory molecules including ICAM-1, IFN-γ, CXCL8/IL-8, IL-6, TNF-α and IL-12p70 were detected in 100% of the patients, while IL-1α, IL-1β and IL-10 were detected in 56.25%, 13.60% and 45.83% of the patients, respectively. Moreover, ICAM-1, IL-8, IL-6, TNF-α, IL-12p70 and IFN-γ were detected in 86.67–100% of the healthy subjects, and the detection rates of IL-10, IL-1α and IL-1β were below 50%. The levels of IL-8, IL-6, IFN-γ and ICAM-1 were significantly higher in the patient group compared with the control group. In addition, IL-8 and IL-6 were negatively correlated with Schirmer I test. Besides, IFN-γ was negatively correlated with tear film breakup time. Furthermore, ICAM-1 and IL-6 were positively correlated with meibography score. Conclusions Collectively, patients with MGD-related EDE had higher levels of inflammatory molecules in their tears, and some molecules were correlated with ocular surface parameters. These findings suggested that inflammation played an important role in MGD-related EDE, and several inflammatory molecules could be used in the diagnosis and the treatment of MGD-related EDE.

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A study to assess the efficacy of topical cyclosporine A 0.05% in the management of dry eye with meibomiam gland dysfunction

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.134 ◽

2022 ◽

Vol 7 (4) ◽

pp. 667-671

Author(s):

Prajwalli Reddy ◽

Wajeeha Umam

Keyword(s):

Dry Eye ◽

Cyclosporine A ◽

Ocular Surface ◽

Tear Film ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Control Group ◽

Dry Eyes ◽

Group A ◽

Group B

: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Meibomian Gland Dysfunction (MGD) is an abnormality of the meibomian gland that blocks the secretion of lipids. Without sufficient lipid production, tears evaporate quickly causing Dry Eye.MGD is associated with multiple pathological mechanisms including inflammation, microbial factors and lipid deficiencies. Topical Cyclosporine A (CsA) 0.05% is a calcineurin inhibitor that reduces inflammation by specifically inhibiting T‑cell activity, which reduces ocular surface inflammation and improves tear film dynamics. This was a prospective observational study done on 100 patients at the Department of Ophthalmology Basaveshwar teaching and general hospital, on patients of dry eyes due to meibomian gland dysfunction. Patients who were diagnosed with dry eyes due to meibomian gland dysfunction were invited to take part in the study. Patients were divided randomly into two groups of 50 patients each. This study, was explained in detail to them. An informed consent was obtained. Patients fulfilling the inclusion criteria were listed.All OSDI scores (symptom intensity, frequency and aggravation) revealed decreasing patterns throughout the observation period in both the groups. In single analysis, the cyclosporine A 0.05% group showed a significant improvement for each score at 3 months (p < 0.01, p = 0.01, p = 0.02, respectively). The mean TBUT after treatment in the group A (cyclosporine A group) increased to 12.36± 3.58(p<0.001) seconds, and in the group B (Control group) the TBUT score increased to 11.01±3.06 seconds. After 3 Months, there was statistically significant improvement in the mean Schirmer’s scores in both the treatment groups, however improvement was significantly greater in Cyclosporine A group. Prior to the treatment in group A (Cyclosporine A) mean Lissamine staining score was 2.73±0.15 and post treatment it reduced to 1.32±0.15 which was statistically significant (P<0.001). In group B (Control group) score before treatment was 2.46±0.15 and after treatment it reduced to 2.39±0.27 (p=0.11), not much difference was seen. : Findings from our study showed that there were significant improvements in the dry eye conditions due to defect in meibomian gland by treatment of topical Cyclosporine A 0.05% and sodium hyaluronate 0.1%.

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Meibomian Gland Dysfunction

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v35i1.866 ◽

2019 ◽

Vol 35 (1) ◽

Author(s):

Sameera Irfan

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Treatment Strategies ◽

Tear Film ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Meibomian Gland Dysfunction ◽

Eye Disease ◽

Treatment Protocols ◽

Dry Eyes

Dry eyes is a common, chronic condition that has a prevalence of about 5- 50%.1 According to the Dry Eye Workshop II report (DEWS II report), published in 2017, the updated definition of Dry Eye Disease is, “a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyper-osmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.” The Tear Film & Ocular Surface Society (TFOS) released their report on the international work on Meibomian Gland Dysfunction (MGD)2 in 2011, which defined MGD, classified it and considered it as the primary cause of dry eye disease worldwide. Previously dry eye disease was considered as an aqueous deficiency problem, but after this report by TFOS, there is a paradigm shift towards “not producing enough lipids to retain the tears that are being produced”. This has led to a huge impact on the treatment protocols which were previously focused on managing the sequelae and symptoms of dry eyes rather than targeting directly on the underlying cause, the MGD. It has now been accepted worldwide that dry eye occurs when the ocular surface system cannot adequately protect itself from the desiccating stress due to the lack of a healthy meibomian gland secretion. This article is mainly focussed on the Meibomian Gland Dysfunction, discussing the normal anatomy of the glands, how they are affected by disease, its implications on the ocular surface and finally, the various treatment strategies. Key words: Blepharitis, Dry eyes, Meibomian gland dysfunction, blepharospasm.

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Evaluation of Dry Eye and Meibomian Gland Dysfunction in Teenagers with Myopia through Noninvasive Keratograph

Journal of Ophthalmology ◽

10.1155/2016/6761206 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Xiu Wang ◽

Xiaoxiao Lu ◽

Jun Yang ◽

Ruihua Wei ◽

Liyuan Yang ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Meibomian Gland ◽

Normal Group ◽

Meibomian Gland Dysfunction ◽

Noninvasive Method ◽

Normal Range ◽

Ocular Surface Disease Index ◽

Surface Conditions ◽

Meibomian Gland Secretion

Purpose. This study aims to evaluate dry eye and ocular surface conditions of myopic teenagers by using questionnaire and clinical examinations.Methods. A total of 496 eyes from 248 myopic teenagers (7–18 years old) were studied. We administered Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp examination, and Keratograph 5M. The patients were divided into 2 groups based on OSDI dry eye standard, and their ocular surfaces and meibomian gland conditions were evaluated.Results. The tear meniscus heights of the dry eye and normal groups were in normal range. Corneal fluorescein scores were significantly higher whereas noninvasive break-up time was dramatically shorter in the dry eye group than in the normal group. All three meibomian gland dysfunction parameters (i.e., meibomian gland orifice scores, meibomian gland secretion scores, and meibomian gland dropout scores) of the dry eye group were significantly higher than those of the normal group (P<0.0001).Conclusions. The prevalence of dry eye in myopic teenagers is 18.95%. Meibomian gland dysfunction plays an important role in dry eye in myopic teenagers. The Keratograph 5M appears to provide an effective noninvasive method for assessing ocular surface situation of myopic teenagers.

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Dry eye and Meibomian gland dysfunction evaluation in sarcoidosis patients

European Journal of Ophthalmology ◽

10.1177/11206721211006579 ◽

2021 ◽

pp. 112067212110065

Author(s):

Pelin Kiyat ◽

Melis Palamar ◽

Bengu Gerceker Turk

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Tear Film ◽

Surface Damage ◽

Meibomian Gland ◽

Drop Out ◽

Meibomian Gland Dysfunction ◽

Ocular Surface Disease Index ◽

Group 2 ◽

Group 1

Purpose: To analyze the relation between Meibomian gland dysfunction, dry eye, and sarcoidosis. Materials and Methods: Twenty eyes of 10 sarcoidosis patients (Group 1) and 20 left eyes of 20 age-sex matched healthy volunteers (Group 2) were included. Presence of dry eye was evaluated with Schirmer 1 test, tear film break-up time (T-BUT), Oxford scale scoring, Ocular Surface Disease Index (OSDI) score assessments. A slit-lamp biomicroscope infrared filter (Topcon, SL-D701, IJssel, The Netherlands) was used to evaluate Meibomian glands. The drop-out ratio according to meibography was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total Meibomian gland area). Results: Among dry eye tests mean Schirmer 1 and T-BUT values were lower and OSDI score was higher in Group 1 compared to Group 2 and the differences were statistically significant ( p = 0.017, p = 0.039, p = 0.003, respectively). In addition, the upper, lower and total meiboscores were statistically significantly higher in Group 1 ( p = 0.047, p = 0.003, p = 0.005, respectively). Conclusion: A significantly higher presence of dry eye and Meibomian gland drop out ratios was detected in sarcoidosis patients. It is important to monitor sarcoidosis patients for dry eye and Meibomian gland dysfunction and when detected, to treat adequately to prevent ocular surface damage.

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Meibomian Gland Dysfunction: Intense Pulsed Light Therapy in Combination with Low-Level Light Therapy as Rescue Treatment

Medicina ◽

10.3390/medicina57060619 ◽

2021 ◽

Vol 57 (6) ◽

pp. 619

Author(s):

Leonidas Solomos ◽

Walid Bouthour ◽

Ariane Malclès ◽

Gabriele Thumann ◽

Horace Massa

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Light Therapy ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Meibomian Gland Dysfunction ◽

Eye Disease ◽

Low Level Light Therapy ◽

Rescue Treatment ◽

Intense Pulsed Light Therapy

Background and Objectives: Evaporative dry eye disease is frequently associated with meibomian gland dysfunction. Patients are often unhappy because of daily drops, care burden, and suboptimal conventional treatments. In this study, we assessed the efficacy of a novel device, the Eye-light®, a combination of intense pulsed light therapy and low-level light therapy, as a novel treatment for meibomian gland dysfunction and dry eye disease. Materials and Methods: This was a retrospective, single-center study carried out over a 6-week period, in which 22 eyes from 11 patients were included. Each patient received four combined light therapy treatment sessions, once weekly over 4 weeks. Patients underwent a clinical examination and filled out a standardized questionnaire to evaluate symptoms one week prior to treatment, and one week after the fourth session. Results: Combined light therapy improved several ocular surface outcome measures in our patients. This study demonstrates that this adjunctive treatment significantly improves the ocular surface and quality of life of patients with dry eye disease and meibomian gland dysfunction. Conclusions: Combined light therapy may be included in meibomian gland dysfunction treatment protocols as an adjunctive rescue treatment.

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Meibomian gland dysfunction is highly prevalent among first-time visitors at a Norwegian dry eye specialist clinic

Scientific Reports ◽

10.1038/s41598-021-02738-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Reza A. Badian ◽

Tor Paaske Utheim ◽

Xiangjun Chen ◽

Øygunn Aass Utheim ◽

Sten Ræder ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Predictive Value ◽

High Sensitivity ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Positive Symptom ◽

Ocular Surface Disease Index ◽

Gland Function ◽

First Time

AbstractTo investigate the prevalence of meibomian gland dysfunction (MGD) in patients presenting with subjective dry eye-related symptoms at their first-time consultation in a Norwegian specialized ocular surface clinic. Additionally, to explore the accuracy of the ocular surface disease index score (OSDI) as an extensively applied tool to assess the severity of dry eye symptoms and MGD diagnosis. Patients with subjective dry eye-related complaints (n = 900) attending the clinic for the first time, from 2012 to 2016, were included in the study. At the baseline, patients completed the OSDI questionnaire. Subsequently, objective clinical tests, including fluorescein break-up time (FBUT), Schirmer-I test, ocular surface staining (OSS), and meibomian gland function assessment using gland expressibility and meibum quality were performed. The association between MGD and its severity in relation to symptom severity defined by OSDI-score was examined. MGD was found in 93.8% of the study group. MGD prevalence was not significantly different between groups based on age (p = 0.302) or sex (p = 0.079). There was a significant association between severity of MGD and dry eye-related symptoms (p = 0.014). OSS was significantly higher in patients with severe symptoms (p = 0.031). Sensitivity and specificity of positive symptom-score (OSDI ≥ 13) for disclosing MGD were 85.5% and 30.4%, respectively. MGD was highly prevalent, not associated with age and sex. OSDI ≥ 13 had high sensitivity and high positive predictive value (PPV), but low specificity and negative predictive value (NPV) for disclosing MGD. This underscores the importance of meibomian gland assessment in patients with dry eye-related symptoms.

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Meibom-mirigy-diszfunkció és a száraz szem

Orvosi Hetilap ◽

10.1556/650.2021.31958 ◽

2021 ◽

Vol 162 (2) ◽

pp. 43-51

Author(s):

Balázs Kovács ◽

Boglárka Láng ◽

Anna Takácsi-Nagy ◽

Györgyi Horváth ◽

Cecília Czakó ◽

...

Keyword(s):

Effective Treatment ◽

Dry Eye ◽

Ocular Surface ◽

Clinical Signs ◽

Tear Film ◽

Meibomian Gland ◽

Diagnosis And Treatment ◽

Meibomian Gland Dysfunction ◽

Pharmacologic Treatment ◽

Inflammatory Processes

Összefoglaló. A szárazszem-panaszok hátterében gyakran áll Meibom-mirigy-diszfunkció, melynek felismerése kiemelten fontos a hatékony kezelés érdekében. A Meibom-mirigyek kóros működése miatt a termelt lipid nem oszlik el megfelelően a szemfelszínen, így a könnyfilm párolgása fokozódik. A könnytermelési zavar következtében szárazszem-panaszok alakulnak ki, melyek a hagyományos könnypótló kezelésre rendszerint csak átmenetileg javulnak. A Meibom-mirigy-diszfunkciót gyakran kíséri a szemhéjszél Demodex-atka-fertőzése – az atka eradikálása szükséges a mirigyek működésének helyreállításához és ezáltal a panaszok megszüntetéséhez. A Meibom-mirigy-diszfunkció a leggyakrabban enyhe formában jelentkezik; a terápia ilyenkor a beteg által is elvégezhető szemhéjtisztításból áll, míg a gyógyszeres kezelés csak az előrehaladottabb, kifejezett gyulladással járó formákban szükséges. Az összefoglaló áttekinti a Meibom-mirigy-diszfunkció klinikai jeleivel és kezelésével kapcsolatos legfontosabb tudnivalókat, különös tekintettel a Demodex-fertőzés felismerésére és kezelésére vonatkozóan. Orv Hetil. 2021; 162(2): 43–51. Summary. The onset of dry eye complaints is often a result of Meibomian gland dysfunction and its diagnosis is essential for effective treatment. In the case of Meibomian gland dysfunction, there is an increased evaporation of the tear film due to the abnormal secretion of lipids that cannot spread on the ocular surface. The treatment of dry eye complaints associated with Meibomian gland dysfunction with tear supplementation is usually ineffective and only results in an intermittent relief of complaints. Meibomian gland dysfunction is often associated with Demodex infestation of the eyelids, and eradicating the mites is essential to re-establish normal meibum production and thus, decreasing ocular complaints. In most cases, Meibomian gland dysfunction is mild, and the treatment of these forms is based on ocular hygiene performed by the patient, while only more advanced forms with inflammatory processes require pharmacologic treatment. This review summarizes the most important knowledge on the clinical signs and treatment of Meibomian gland dysfunction with particular attention to the diagnosis and treatment of ocular Demodex infection. Orv Hetil. 2021; 162(2): 43–51.

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The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population

Acta Ophthalmologica ◽

10.1111/aos.13732 ◽

2018 ◽

Vol 96 (6) ◽

Cited By ~ 9

Author(s):

Dieter Franz Rabensteiner ◽

Haleh Aminfar ◽

Ingrid Boldin ◽

Gerold Schwantzer ◽

Jutta Horwath‐Winter

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Tear Film ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Surface Parameters ◽

Clinic Population ◽

Eye Clinic

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Characterization of Meibomian Gland Dysfunction in Patients with Rosacea

10.21203/rs.3.rs-44163/v1 ◽

2020 ◽

Author(s):

Eduardo Buzolin Barbosa ◽

Carla Melo Tavares ◽

Dimitri Felipe Luz da Silva ◽

Lorraine Souza Santos ◽

Andrea Fernandes Eloy da Costa França ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Tear Film ◽

Meibomian Gland ◽

Rupture Time ◽

Meibomian Gland Dysfunction ◽

Ocular Involvement ◽

Conjunctival Hyperemia ◽

Film Rupture ◽

Glandular Secretion

Abstract Background: Rosacea frequently evolve the eyes with impact on life and vision quality. There are gaps in the understanding of ocular involvement, specially related to eyelid glands, which share common features to sebaceous glands.Purpose: Describe ocular surface disease related to Rosacea and its associations.Methods: Ninety-three individuals were selected to this cross-sectional, observational, non-interventionist study, divided into groups: rosacea (n=40) and controls (n=53). We investigated objective parameters of the ocular surface (conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, ocular surface staining) comparing healthy individuals with rosacea patients.Results: 69.23% of rosacea group were women, mean age of 47.34 ± 12.62 years old. Compared to matched controls there was no statistically significant differences regarding to visual acuity (p=0.987) and tear film parameters (tear meniscus height (p=0.338), non-invasive tear film rupture time (NIBUT) (p= 0.228), invasive rupture time (TBUT) (p=0.471) and Schirmer's test (p=0.244)) as well as conjunctival hyperemia (p = 0.106), and fluorescein staining (p = 0.489). Significant association was found in meibography evaluation (p = 0.026), mucous layer integrity (p = 0.015) and ocular surface symptoms (p <0.0001). Rosacea patients also showed important eyelid changes: glandular expressibility (p <0.001), glandular secretion pattern (p <0.001) and telangiectasia (p <0.001) compared to controls.Conclusion: Meibomian gland dysfunction is frequently associated to dermatologic conditions and is characterized by morphological findings in the meibography as well as lipid secretion impairment that lead to evaporative dry eye and ocular surface dysfunction and inflammation.

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