Meibomian gland disfunction in computer vision syndrome

This article reviews ethiology and pathogenesis of dry eye syndrome due to meibomian gland disfunction (MDG). It is showed that blink rate influences meibomian gland functioning and computer vision syndrome development. Current diagnosis and treatment options of MDG are presented.     

Meibomian gland dysfunction in floppy eyelid syndrome

A 41-year-old obese man presented with bilateral ocular irritation and clinical findings consistent with floppy eyelid syndrome. Light- and electron-microscopic examination of tarsus removed at surgical correction revealed cystic degeneration and squamous metaplasia of the meibomian glands, along with abnormal keratinization and granuloma formation. These findings, not reported before in this syndrome, suggest that meibomian gland dysfunction with attendant qualitative abnormalities of the tear film, may be partly responsible for the keratoconjunctivitis seen in this syndrome.     

Meibomian gland dysfunction. III. Meibomian gland lipids

The lipid components of meibomian gland excreta were evaluated in rabbits after they received 2% topical epinephrine dropped into their eyes daily for a period of 6 months to a year to induce meibomian gland dysfunction (MGD). Changes were compared to excreta obtained from seven age-matched, untreated control rabbits. Comparison of the lipids from MGD lids with lipids obtained from control rabbits revealed, for clinically evident MGD, a marked increase in the lipids that are uniquely characteristic of epidermal tissue. These epidermal lipids are free sterols (large amounts) and a group of seven types of ceramides. The data are consistent with the hypothesis that the initiating factor of rabbit MGD is hyperkeratinization of the ductal epithelia. For clinically apparent MGD some hydrolysis of the sterol esters of the meibomian gland lipids also seems to have occurred. This was evidenced by the formation of an 8-fold increase in a cluster of anteiso fatty acids with chain lengths longer than C20 in the free fatty acid fraction. This group of free fatty acids was the same as the acids esterified to the sterol esters. We could detect no change in the lipid excreta obtained from rabbits that developed only subclinical MGD, consisting of orifice plugging and dilation of the duct.     

Meibomian gland dysfunction

Meibomian gland dysfunction (MGD) is a chronic disease, usually caused by obstruction of the secretory Meibomian glands. The subsequent reduction of gland secretion results in a decreased amount of lipids in the tear film. This results in a faster evaporation of the tear film and thus an evaporative dry eye. MGD alone is responsible for about 60% of all cases in combination with aqueous deficiency for a further 20% of dry eyes. While in Europe up to 20% of the population are suffering from MDD, this is true in Asia for over 60% of the population. MGD is more common in women and it incidence increases with age. It is influenced by the hormonal status as well as chemical and mechanical noxious stimuli. Additional risk factors include various skin diseases such as rosacea, acne or atopy. To diagnose MGD, particular attention should be paid to changes in the lid margin such as plugging or pouting of the ducts, thickening and telangiectasia. However, most important is the diagnostic expression of the glands. At first it should be assessed whether secretion can be caused by pressure to the eyelid against the globe and secondly the quality of the expressed secretions should be evaluated. MGD should be treated according to the severity of the disease. While in mild stages instructions for lid margin hygiene, warming and massage in combination with artificial tears might be sufficient, in more severe stages oral tetracyclin derivatives and anti-inflammatory eye drops such as steroids or CSA are necessary for successful treatment.     

玻璃棒法按摩睑板腺联合常规疗法治疗睑板腺功能障碍的临床疗效

目的：探讨玻璃棒法按摩睑板腺与常规疗法联合治疗睑板腺功能障碍(MGD)的临床疗效。

方法：回顾性分析2016-08/2017-06我院收治的MGD患者130例220眼,根据治疗方式不同进行分组,其中给予常规治疗即1g/L氟米龙滴眼液联合自行热敷的患者设为对照组(65例112眼),给予圆头玻璃棒按摩睑板腺联合常规疗法的患者设为联合组(65例108眼)。比较两组患者治疗前后眼表疾病指数量表(OSDI)评分、泪膜破裂时间(BUT)、基础泪液分泌试验(SⅠt)、角膜荧光素染色(CFS)评分、睑缘评分、睑板腺分泌物性状评分和眼压情况及临床治疗有效率。

结果：治疗前,两组患者OSDI评分、BUT、SⅠt、CFS评分、睑缘评分、睑板腺分泌物性状评分、眼压情况差异均无统计学意义(P>0.05)。治疗2wk后,联合组患者OSDI、CFS、睑缘及睑板腺分泌物性状评分均低于对照组,BUT和SⅠt均大于对照组,差异均有统计学意义(P<0.01); 两组患者眼压均有所升高,但均≤21mmHg,两组间差异无统计学意义(P>0.05)。治疗2wk后,联合组总有效率为92.6%(100/108),对照组总有效率为78.6%(88/112),差异具有统计学意义(P<0.05)

结论：玻璃棒法按摩睑板腺与常规疗法联合治疗MGD能够有效改善眼表症状和睑板腺分泌功能,促进泪液分泌,提高临床治疗有效率。     

Prevalence of Meibomian gland dysfunction

This study was performed to determine the prevalence of Meibomian gland dysfunction (MGD) and to determine which patient profile factors might be associated with the syndrome. Patients were randomly selected, apparently normal patients presenting for routine vision examinations. Of the 398 patients for whom Meibomian gland expression was performed and a detailed history obtained, 155 patients or 38.9% exhibited MGD based on the principal clinical criterion of an absent or cloudy Meibomian gland secretion upon expression. Patient profile factors of gender, age, allergy occurrence, and contact lens wear were analyzed for correlation with MGD. Age was found to be the only significant correlating factor (positive correlation, p less than 0.0001).     

Meibomian gland dysfunction in chronic blepharitis

We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.     

睑板腺功能障碍患者IntraLase-LASIK术前睑板腺处理的临床观察

目的：：观察睑板腺功能障碍患者术前行睑板腺处理对飞秒激光制瓣膜的准分子激光角膜原位磨镶术( IntraLase-LASIK)术后眼表炎症反应和泪膜状态的改变。方法：选取2014-03/09来我院屈光门诊就诊拟行IntraLase-LASIK术并有不同程度睑板腺功能障碍的患者35例70眼。随机数字法将患者分为两组：观察组17例34眼术前给予睑板腺的特殊处理,对照组18例36眼术前不进行睑板腺处理,两组其余操作相同。观察IntraLase-LASIK术后1 d和1 wk眼球结膜充血、畏光、干涩感评分及泪膜破裂时间( tear break-up time,BUT)的变化。结果：术后1 d和1 wk观察组的球结膜充血、畏光、干涩感评分及BUT均低于对照组( P<0.05)。结论：睑板腺功能障碍的患者术前睑板腺处理可以减轻术后的眼表刺激症状,对泪膜起到一定的稳定作用,提高患者术后的满意度。     

白内障超声乳化术前睑板腺按摩对合并睑板腺功能障碍患者术后眼表的影响

目的：：探讨合并有睑板腺功能障碍( Meibomian gland dysfunction,MGD)的白内障患者在术前行睑板腺按摩对术后眼表的影响。方法：选取合并MGD的白内障患者90例93眼,随机分为两组,试验组在术前1 wk每天行眼睑部热敷及睑板腺按摩,对照组不采取措施。两组患者均行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1 wk进行裂隙灯显微镜检查,记录并比较两组的睑缘形态评分、睑板腺分泌物评分、泪液分泌试验( Schirmer Ⅰ test,SⅠt)、泪膜破裂时间( break-up time,BUT)结果。结果：与术前相比,对照组的睑缘形态评分、睑板腺分泌物评分显著提高,BUT和SⅠt显著下降。而试验组的术后睑缘形态评分、睑板腺分泌物评分、BUT和SⅠt均较对照组显著改善(P<0.05)。结论：超声乳化手术可以加重合并MGD患者的睑板腺功能,破坏眼表状态,而术前行睑板腺按摩可以显著改善白内障术后MGD患者的眼表状态。     

Meibomian gland loss due to trabeculectomy

Purpose

To evaluate meibomian gland loss after trabeculectomy with mitomycin C (MMC).

Methods

This cross-sectional observational case study involved 55 eyes in 39 patients who had undergone trabeculectomy with MMC administered to the upper area of the eye. We used a mobile pen-shaped noncontact meibography system to access the morphology and determine loss of the meibomian glands. Meibomian gland loss was scored (meiboscore) from grade 0 (no loss of the meibomian glands) through grade 3 (loss of more than two-thirds of the total area) in the bleb-contacting and bleb-noncontacting upper eyelid areas in the primary position and in the lower eyelid. The tear film breakup time (BUT) was also measured.

Results

The median duration from trabeculectomy to examination was 7.4 years (interquartile range 3.1–14.2). The meiboscores of the bleb-contacting upper eyelid areas were significantly higher than those for the bleb-noncontacting upper eyelid areas (P < 0.001). The meiboscores for both the bleb-contacting and the bleb-noncontacting upper eyelid areas were significantly higher when the bleb was avascular (P = 0.011 and P = 0.008, respectively). The meiboscores of the bleb-contacting and bleb-noncontacting upper eyelid areas showed a significant negative correlation with the BUT (r = ?0.330, P = 0.014 and r = ?0.296, P = 0.028, respectively).

Conclusion

Blebs that occur after trabeculectomy with MMC may be the cause of meibomian gland loss, particularly when the bleb is avascular. The presence of an avascular bleb warrants extra vigilance for decreased meibomian gland secretions because this decrease can lead to tear dysfunction and ocular surface damage, including bleb-wall damage.     

Meibomian gland dysfunction in a case of ichthyosis follicularis with alopecia and photophobia syndrome

We are reporting an interesting case of ichthyosis follicularis with alopecia and photophobia syndrome in a daughter and father from the Indian subcontinent associated with Meibomian gland dysfunction. A three-year-old female child presented with pain, redness and severe photophobia in both eyes since one month. Cutaneous examination revealed ichthyosis, absence of hair all over the body including eyebrows, scalp and angular cheilosis. Ocular examination revealed bilateral severe meibomianitis, multiple superficial punctate keratitides in right eye and corneal epithelial defect in the left eye. Other systemic features were prominent high forehead and large ears. Her father had similar symptoms. Her symptoms improved after adequate treatment of meibomian gland dysfunction. She is asymptomatic at present.     

Meibomian gland adenocarcinoma with regional lymph node metastasis

Meibomian gland carcinoma of the eyelid is a common neoplasm which clinically simulates a benign condition of chalazion. Although growing slowly, metastasis to regional lymph nodes is frequent, at a rate of 17-28% in this country. Eleven (11) cases of Meibomian gland carcinoma with regional lymph node metastasis are reported, and the therapeutic modalities have been tailored to suit the individual cases, including full-thickness local excision, orbital exenteration, radical cervical dissection, and superficial parotidectomy.     

蠕形螨感染致睑板腺功能障碍的临床研究

目的：分析蠕形螨相关性睑板腺功能障碍(MGD)患者的临床情况及综合治疗对蠕形螨感染状态的影响。

方法：前瞻性病例对照研究。选取2016-01/2017-06在沈阳何氏眼科医院门诊就诊的MGD患者132例264眼(试验组)及基本资料相匹配的健康志愿者96例192眼(对照组)。试验组患者进行综合治疗。两组受检者均进行睫毛采样镜检蠕形螨感染情况,并进行泪膜破裂时间(BUT)、Schirmer Ⅰ试验(SⅠt)、角膜荧光染色(FL)评分检查; 试验组患者同时进行主观症状评分检查。

结果：治疗前,试验组和对照组受检者蠕形螨感染数量分别为7(6,9)、2(1,3)个/眼,差异有统计学意义(Z=5.264,P<0.01); 蠕形螨阳性率分别为100.0%和28.1%,差异有统计学意义(χ²=35.957,P<0.01); BUT分别为4.06±1.38、12.00±2.82s,FL评分分别为3.06±1.57、0.46±0.63分,SⅠt分别为6.93±2.08、11.13±2.38mm/5min,差异均有统计学意义(t=-9.825、5.978、-4.776,均P<0.01)。治疗前和治疗后4wk,试验组患者主观症状评分分别为6.57±2.93、3.27±1.89分,差异有统计学意义(t=5.443,P<0.01)。治疗后4wk,试验组患者蠕形螨阳性率为57.6%; 蠕形螨数量平均为3(0,5)个/眼,较治疗前明显减少(Z=3.937,P<0.01); BUT、FL评分分别为6.53±3.27s、1.67±0.54分,均较治疗前好转,差异有统计学意义(t=5.152、4.328,均P<0.01),而SⅠt(8.37±5.34mm/5min)较治疗前无明显改变,差异无统计学意义(t=-0.285,P=0.748)。

结论：蠕形螨感染可引起MGD,产生相应的临床症状。综合治疗能降低眼部蠕形螨寄生数量,有效缓解蠕形螨相关性MGD的临床症状。     

强脉冲光治疗睑板腺功能障碍的研究进展

近年来,强脉冲光治疗作为一项新技术因其在治疗睑板腺功能障碍上具有无创、无痛、效果好等优点,在眼科领域得到了进一步发展.本文从强脉冲光治疗的现状、作用机制、操作步骤、治疗结果、安全性等方面对强脉冲光在治疗睑板腺功能障碍中的应用进展进行综述.     

Role of instrumental factors in Meibomian gland contrast assessment

Purpose

Meibomian gland contrast has been suggested as a potential biomarker in Meibomian gland dysfunction. This study analysed the instrumental factors related to contrast. The objectives were to determine whether the mathematical equations used to compute gland contrast (e.g., Michelson or Yeh and Lin), impact the ability to identify abnormal individuals, to ascertain whether contrast between the gland and the background could be an effective biomarker and to assess whether using contrast-enhancement on the gland image improves its diagnostic efficacy.

Methods

A total of 240 meibography images from 40 participants (20 controls and 20 having Meibomian gland dysfunction or blepharitis), were included. The Oculus Keratograph 5M was used to capture images from the upper and lower eyelids of each eye. The contrast of unprocessed images and those pre-processed with contrast-enhancement algorithms were analysed. Contrast was measured on the eight central glands. Two equations for contrast computation were used, and the contrast both between glands and within a gland were calculated.

Results

Significant differences were found between the groups for inter-gland area in the upper (p = 0.01) and lower eyelids (p = 0.001) for contrast measured with the Michelson formula. Similar effects were observed when using the Yeh and Lin method in the upper (p = 0.01) and lower eyelids (p = 0.04). These results were obtained for images enhanced with the Keratograph 5M algorithm.

Conclusions

Meibomian gland contrast is a useful biomarker of disease related to the Meibomian glands. Contrast measurement should be determined using contrast-enhanced images in the inter-gland area. However, the method used to compute contrast did not influence the results.     

Meibomian gland function and the tear lipid layer

The meibomian glands of the lid produce a lipid material whose synthesis is dependent on neuronal, hormonal, and vascular factors. This lipid material is fluid, spreads easily, is a surfactant as well as an aqueous barrier and must remain functional after a blink. To satisfy these requirements, the meibomian lipids have a specific composition. Even after delivery it may be modified by lipases produced by ocular bacteria, and modifications in the lipid components can lead to unique disease states. For example, bacteria may degrade lipids, producing an unstable tear film and irritating free fatty acids; and hormonal imbalances may alter lipid profiles to destabilize the tear film and produce evaporative dry eye.     

Meibomian gland function and giant papillary conjunctivitis.

We examined 42 contact lens-wearing patients for clinical evidence of giant papillary conjunctivitis and for meibomian gland dysfunction with gland dropout. Fifteen patients were free of clinical signs and symptoms of giant papillary conjunctivitis, whereas 27 had clinical symptoms and evidence of giant papillary conjunctivitis. Patients with giant papillary conjunctivitis had significantly more gland dropout with an average of 0.6 +/- 1.2 gland absent in both lower eyelids compared with 0.2 +/- 0.4 gland absent in patients without giant papillary conjunctivitis. Additionally, the viscosity of meibomian gland excreta was greater in the giant papillary conjunctivitis group. There was no difference in tear osmolarity or in the Schirmer test results between the two groups. These results indicated patients with giant papillary conjunctivitis were more likely to have meibomian gland dysfunction with gland dropout than patients without giant papillary conjunctivitis.