Functional and Morphological Evaluation of Meibomian Glands in the Assessment of Meibomian Gland Dysfunction Subtype and Severity - 12/11/19

Doi : 10.1016/j.ajo.2019.09.005

Jiaxin Xiao ^a,^b,^⁎ , Muhammed Yasin Adil ^a,^b, Xiangjun Chen ^c,^d,^e,^f,^g, Øygunn A. Utheim ^c, Sten Ræder ^c, Kim Alexander Tønseth ^b,^h, Neil S. Lagali ^d,ⁱ, Darlene A. Dartt ^j, Tor P. Utheim ^b,^d,^e,^f,^g,^h,^k
^a Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
^b Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
^c The Norwegian Dry Eye Clinic, Oslo, Norway
^d Department of Ophthalmology, Sørlandet Hospital, Arendal, Norway
^e Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
^f Institute of Clinical Dentistry/Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
^g Faculty of Health Sciences, National Centre for Optics, Vision and Eye Care, University College of Southeast Norway, Kongsberg, Norway
^h Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
ⁱ Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
^j Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
^k Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway

^∗Inquiries to Jiaxin Xiao, Freserveien 13, 0195 Oslo, NorwayFreserveien 13Oslo0195Norway

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 12 November 2019
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Purpose

To classify subtypes of meibomian gland dysfunction (MGD) and evaluate the dependency of dry eye signs, symptoms, and parameters on MGD subtype.

Design

Cross-sectional study. Study Population: the right eyes of 447 patients with MGD of various subtypes and 20 healthy volunteers.

Methods

Patients were divided into 4 subtypes of MGD based on meibum expression, meibum quality, and MG loss on meibography images (meibograde of 0–6). Subtypes were patients with high meibum delivery (hypersecretory and nonobvious MGD) and those with low meibum delivery (hyposecretory and obstructive MGD). Additional clinical tests included tear film break-up time (TFBUT), ocular staining, osmolarity, Schirmer I, blink interval timing and the Ocular Surface Disease Index (OSDI) questionnaire.

Results

A total of 78 eyes had hypersecretory MGD; 49 eyes had nonobvious MGD; 66 eyes had hyposecretory MGD; and 254 eyes had obstructive MGD. Increased tear film osmolarity and lower TFBUT were found in the low-delivery groups; hyposecretory (P = 0.006, P = 0.016) and obstructive MGD (P = 0.008, P = 0.006) relative to high-delivery MGD (hypersecretory and nonobvious groups, respectively). Worse ocular symptoms and ocular staining were also found in low-delivery MGD groups than the high delivery MGD groups (P < 0.01 and P < 0.006, respectively).

Conclusions

Patients with low-delivery MGD had worse dry eye parameters and ocular symptoms than those with high meibum delivery, indicating the pivotal role of meibum secretion in ocular surface health that should be targeted in MGD therapy. Furthermore, nonobvious MGD cannot be diagnosed using conventional dry eye tests and requires morphologic assessment of meibography images to confirm MG loss.

Le texte complet de cet article est disponible en PDF.