Meibomian gland morphology and tear osmolarity: changes with Accutane therapy.

We evaluated the meibomian gland function of 11 patients before and during treatment with isotretinoin (Accutane) by assessing tear osmolarity, meibomian gland morphology, tear production, rose bengal staining, and meibomian gland excreta. We found, during Accutane use, that meibomian glands appeared significantly less dense and atrophic by meibography. Excreta thickness increased from 1.7 +/- 0.9 to 3.1 +/- 1.2 (p less than 0.005), and expressible excreta volume decreased from 1.52 +/- 0.68 to 1.10 +/- 0.3 (p less than 0.05) (scale 1-4). We also found a significant increase in tear osmolarity from 304.9 +/- 11 to 316.3 +/- 10 mosmol/L (p less than 0.005). There was no significant change in the Schirmer test during treatment. We suggest that the clinical symptoms of blepharitis during Accutane therapy are related to decreased meibomian gland function and consequent increased tear evaporation and tear osmolarity.     

Utility of meibography in the evaluation of meibomian glands morphology in normal and diseased eyelids

PurposeTo study the utility of meibography for the morphology of meibomian glands in normal eyelids and in various eyelid diseases.DesignA cross-sectional study.MethodsA newly designed transilluminator, fitting both the upper along with lower eyelids, and an infrared camera were used to obtain video clips of the meibomian glands for 60 asymptomatic subjects with normal eyelid margin. Parameters studied included, ocular surface, Schirmer test, and tear breakup time (TBUT). The meibomian glands of patients with meibomian glands’ abnormality secondary to infectious, inflammatory, malignant, congenital, or post-radiation therapy disease related etiologies were compared with normal patients. Still pictures were extracted from the video clips to evaluate the meibomian glands for gland dropout and gross morphological changes.ResultsIn normal subjects, meibomian glands appeared to be thinner and longer in the upper eye lids than in the lower eye lids. Gland dropout occured with increased age, more in the lower eye lid and in females. Excessive gland drop out (> 75%) was seen in patients with history of trachoma, Stevens Johnson syndrome, severe blepharitis, and post-radiation for orbital tumors. Variable gland drop out was noticed in patients with floppy eyelid syndrome, and blepharitis. In patients with congenital distichiasis, partial or complete gland drop out at the part of the eyelid margins affected by distichiasis was noticed.ConclusionsThe newly designed transilluminator permitted the examination of both upper and lower eye lid meibomian glands with minimal discomfort. Evaluating the anatomical changes involving meibomian glands with meibography may help increase our understanding of the meibomian gland-related diseases, monitor the effects of treatment, and provide helpful information for patient education.     

睑缘炎患者睑板腺形态变化及其与干眼的关系

背景 睑缘炎是一种常见的眼表疾病,常累及睑板腺体,而睑板腺体所分泌的脂质是泪膜的重要组成成分之一.泪膜稳定性的破坏可导致干眼相关症状,可以说睑缘炎是干眼发病的因素之一,但二者之间的关系有待进一步研究. 目的 使用非接触式红外线睑板腺观察仪观察睑缘炎患者睑板腺腺体的形态,并与干眼相关检查进行相关性分析. 方法 采用病例观察的设计方法对睑缘炎患者睑板腺形态改变与干眼症的关系进行研究.选取2010年9月至2011年4月于河南省眼科研究所眼科门诊依据PPP标准诊断为睑缘炎的患者83例83眼,取得患者的知情同意后,在裂隙灯下行眼前节检查睑缘畸形评分、泪液分泌( Schirmer Ⅰ)试验、泪膜破裂时间(BUT)、角膜荧光素染色评分及结膜充血评分,采用泪膜干涉仪行泪膜形态分级,采用非接触式红外线睑板腺摄像仪行睑板腺腺体缺失分级,对睑缘炎睑板腺腺体缺失分级与上述检查结果的关系进行评估.结果 不同年龄组不同性别间睑缘炎的频数分布差异无统计学意义(x2=2.69,P=0.75).睑缘炎患者的睑板腺腺体缺失分级与年龄星弱的正相关(r=0.58,P=0.00),但与性别无明显相关性(r=-0.09,P=0.99);患者睑板腺体缺失与睑缘畸形评分及结膜充血评分均呈弱的正相关(r=0.64,P=0.00;r=0.50,P=0.00);与泪膜影像分级及角膜染色评分均呈弱的正相关(r=0.23,P=0.04;r=0.50,P=0.00),与BUT呈弱的负相关(r=-0.32,P=0.00),但与Schirmer Ⅰ试验结果无明显相关性(r=-0.05,P=0.69).不同年龄组男性和女性的睑板腺缺失分级评分差异无统计学意义(Z=-0.09,P=0.93).结论 睑缘炎可引起蒸发过强型干眼,且患者的睑板腺体随年龄的增长缺失程度加重.非接触式红外线睑板腺观察仪作为一种有效、快速、无刺激地观察睑板腺体形态的仪器,可作为一项常规检查来辅助诊断睑缘炎.     

Meibomian keratoconjunctivitis.

We evaluated, dermatologically and ophthalmologically, 26 patients who had chronic blepharitis (meibomitis); we also investigated 26 age- and sex-matched controls. All of the blepharitic patients had an abnormality of sebaceous gland function ranging from seborrhea sicca to seborrheic dermatitis or acne rosacea, suggesting a generalized sebaceous gland dysfunction that included the meibomian glands. Sebaceous gland abnormalities most frequently involved the cool areas of the face or scalp. Stagnation of the meibomian glands presumably caused a defect in the tear lipid layer; this resulted in an unstable tear film that produced superficial punctate keratopathy. The break-up time was much lower in these patients than in controls. The break-up time returned to normal or super-normal levels when fresh meibomian secretions were expressed into the tear film. The superficial punctate keratopathy had the characteristics of those seen in conditions with a known unstable tear film and not of those experimentally produced by staphylococcus toxin.     

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.     

In vivo confocal microscopy in blepharitis

BACKGROUND: Dysfunction of the meibomian glands with inflammation and obstruction has been suggested to be an important factor in the pathogenesis of chronic blepharitis. Few objective tests are, however, available to examine the meibomian glands directly. PATIENTS AND METHODS: Nineteen patients with anterior blepharitis, meibomitis, meibomian gland dysfunction or severe keratoconjunctivitis sicca associated with blepharitis as well as 10 patients with normal lid margins were examined with the HRTII/RCM in vivo confocal microscope. Scans of the tear film, the tarsal conjunctiva, the hair follicles and the meibomian glands were analysed by a masked observer. RESULTS: Patients with normal lid margins exhibited a minimal round cell infiltrate in the tarsal conjunctival epithelium and largely normal ducts of the meibomian glands lined with a multilayered epithelium as well as normal gland acini. In patients with anterior blepharitis, blepharitis associated with autoimmune peripheral ulcerative keratitis and blepharitis in the context of severe dry eye, confocal microscopy disclosed normal meibomian glands. In 12 patients with blepharitis/meibomitis or meibomian gland dysfunction, profound pathology was visible with dilatation and obstruction of the meibomian gland ducts. In 15 of 19 patients with blepharitis/meibomitis, but not in meibomian gland dysfunction, an intense inflammation was observed in the tarsal conjunctival epithelium and stroma. In one patient, demodex folliculorum was evident in vivo. In patients with normal lid margins as well as in patients with blepharitis, hair follicles appeared within normal limits. CONCLUSIONS: In vivo confocal microscopy allowed the examination of the tear film, the tarsal conjunctiva, the lid margin including the lash follicles and the meibomian glands. In patients with meibomian gland disease pathological changes could be visualised and documented objectively. The presence of an inflammatory infiltrate permitted us to differentiate between meibomitis and meibomian gland dysfunction. Changes of the lash follicles do not seem to play an important role in blepharitis. Thus, in vivo confocal microscopy represents an objective technique in the classification and follow-up of patients with blepharitis.     

Association between meibomian gland changes and aging, sex, or tear function

PURPOSE: To study changes in the lid margin and meibomian glands and their association with aging, sex, and tear function. METHODS: We examined 354 eyes in 177 subjects (76 men and 101 women; 21-93 years; mean age, 63.0 +/- 14.3 years) with no ocular symptoms or ocular surface disorders. Anatomic changes in the lid margin were studied using slit-lamp biomicroscopy. Meibomian gland function and morphology were evaluated on the basis of meibum expression and meibography, respectively. Tear function and ocular surface epithelium were assessed with the Schirmer test, by tear film break-up time, and with a fluorescein staining test. RESULTS: Eyes with abnormal lid margin anatomy, hyposecretion of meibum, and meibomian gland dropout were seen in 26 (7.3%), 46 (12.4%), and 68 eyes (18.6%), respectively, with a significant association between each finding and aging (P = <0.0001, 0.0498, and <0.0001, respectively). In patients < or =69 years of age, no significant association was found between meibomian gland-related findings and sex. However, a high incidence of abnormal lid margin and gland dropout was noted in men > or =70 years of age compared with women. No significant association was found between changes in the lid margin and meibomian glands and tear function in patients > or =40 years of age. CONCLUSION: Among symptom-free subjects, we found that changes in the lid margin and meibomian glands were closely related to aging. Among elderly subjects, changes in the anatomic lid margin and meibomian gland morphology were observed more frequently in men than in women. Tear function showed no association with either changes in the lid margin or function of the meibomian glands.     

眼表综合分析仪在儿童早期前睑缘炎临床分析中的应用

目的利用眼表综合分析仪对儿童早期前睑缘炎患者的眼表情况进行观察,分析其临床特点。方法描述性研究。选取2015年7月至2016年5月就诊于山西省眼科医院门诊,经裂隙灯显微镜检查确诊为早期前睑缘炎的儿童患者40例（80眼）,年龄4~14岁。对患儿睑缘炎体征进行评分,利用眼表综合分析仪检查其泪膜破裂时间（BUT）、泪河高度,并进行眼表充血、睑板腺缺失及角膜荧光素钠染色评分,对所得数据进行Spearman秩相关分析。结果80眼中,58眼（72%）BUT缩短;50眼（62%）泪河高度下降;15眼（19%）发生角膜上皮点状缺损;25眼（31%）睑板腺缺失范围＞1/3。睑缘炎体征评分与BUT、泪河高度、角膜荧光染色评分及睑板腺缺失评分不相关;睑板腺缺失评分与BUT呈负相关（r=-0.253,P=0.024）,与角膜荧光染色评分呈正相关（r=0.563,P＜0.001）。结论儿童早期前睑缘炎患者泪膜稳定性下降,同时合并睑板腺缺失的患者易继发干眼。     

Relationship between eyelid margin irregularity and meibomian gland dropout

PurposeTo examine the relationship between lid margin abnormalities and meibomian gland loss in infrared meibography.MethodsThis study was a retrospective chart review of 170 patients with dry eye disease. A correlation analysis between eyelid margin abnormalities and meibomian gland dropout in infrared meibography was performed using data from 141 eyes. We graded the following eyelid margin abnormalities: irregular lid margin, vascular engorgement, plugging, anterior placement of the mucocutaneous junction, exposed terminal duct, and presence of tattoos. Multiple regression analyses were performed with meiboscore (meibomian gland dropout grade) as the dependent variable and age, sex, lid margin abnormality grades, and total grading score of lid margin abnormalities as the covariates. In addition, Meibomian glands structure were examined in those with eyelid margin dimpling using meibography in 25 eyes.ResultsIn the multiple regression analysis, an irregular lid margin in the upper eyelid was associated with a higher meiboscore after controlling for age and sex (coefficients B = 1.379, p = 0.025). Other lid margin abnormalities did not significantly affect the meiboscore. In the lower eyelids, irregular lid margin (coefficients B = 0.602, p = 0.009) and total grading score of lid margin abnormality were associated with higher meiboscores (coefficients B = 0.100, p = 0.022). Of the 25 eyes with dimples, 21 (84%) showed focal or complete meibomian gland loss at the site.ConclusionsLid margin abnormalities were found to be associated with meibomian gland dropout.     

Tear film and ocular surface changes after closure of the meibomian gland orifices in the rabbit

To determine whether meibomian gland dysfunction can increase tear film osmolarity and produce ocular surface changes analogous to those seen with lacrimal gland disease (keratoconjunctivitis sicca [KCS]), the authors closed the meibomian gland orifices in the right eyes of 11 rabbits by light cautery and studied the changes for 20 weeks. Tear film osmolarity was increased throughout the observation period. Conjunctival goblet cell density and corneal epithelial glycogen levels declined progressively. Closure of the meibomian gland orifices thus increased tear film osmolarity in the presence of normal lacrimal gland function and caused ocular surface abnormalities similar to KCS.     

Changes of meibomian glands in patients with type 2 diabetes mellitus

AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus (DM). METHODS: Of 118 eyes (118 patients) with type 2 DM (DM group) and 100 eyes of 100 control subjects (control group) were enrolled. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NI-BUT) and the structure of the meibomian glands (MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0 (no loss) to grade 3 (lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy (LSCM). The primary outcomes were meibomian gland acinar unit density (MGAUD), meibomian gland acinar longest diameter (MGALD) and meibomian gland acinar shortest diameter (MGASD). RESULTS: Compared with control group, the OSDI was significantly higher in DM group (Z=-5.916; P<0.001), while the NI-BUT was significantly lower (Z=-7.765; P<0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group (Z=-3.937; P<0.001). LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group (Z=-10.120, -9.4442, -7.771; P<0.001). CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye. Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.     

Giant papillary conjunctivitis and meibomian gland dysfunction blepharitis.

In this prospective pilot study we saw 42 consecutive giant papillary conjunctivitis (GPC) patients (80 eyes), all of whom were found to have some meibomian gland dysfunction blepharitis. Severity of GPC at presentation correlated with severity of meibomian gland dysfunction blepharitis (Kendall's tau b averaged 0.246 across the adjusted statistical analyses). Thirty-two patients (63 eyes) were refit after treating meibomian gland dysfunction blepharitis. Twenty-eight of these patients (55 eyes; 87%) continue to wear contact lenses, maintaining an improvement in GPC (mean follow-up 21 months; range 11-36 months). We hypothesize that meibomian gland dysfunction blepharitis may play a role in the pathogenesis of GPC and suggest that a large, controlled, multi-observer study be performed to further investigate this possible association.     

睑板腺形态及功能与阻塞性睡眠呼吸暂停综合征的关系

目的探讨阻塞性睡眠呼吸暂停综合征（OSAHS）患者睑板腺形态结构及其泪膜稳定性的改变。方法描述性研究。选取2013年11月至2014年6月期间于我院呼吸内科确诊为OSAHS的患者63例（126眼）作为OSAHS组,同期体检中心健康体检人群44例（88眼）作为对照组。对全部纳入对象询问个人基本信息及病史,并对眼表疾病指数（OSDI）进行评分后,再进行裂隙灯显微镜、非接触式红外线睑板腺成像仪、泪膜破裂时间（BUT）、睑板腺分泌物性状等眼部检查。结果睑板腺缺失发生率在对照组,轻度、中度、重度OSAHS患者中分别为12/88（14%）、7/18（39%）、14/30（47%）、53/78（68%）,组间差异有统计学意义（χ²=50.62,P＜0.01）;轻度、中度、重度OSAHS患者睑板腺缺失评分分别为2.29±1.25、2.29±0.91、2.64±1.18,差异无统计学意义。对照组,轻度、中度、重度OSAHS患者中睑板腺扭曲发生率分别为8/88（9%）、6/18（33%）、12/30（40%）,49/78（63%）,组间差异有统计学意义（χ²=51.96,P＜0.01）。OSAHS组睑板腺开口堵塞发生率（69%）、分泌物性状改变发生率（72%）较对照组高（分别为36%、39%）,差异均有统计学意义（χ²=22.42、27.26,P＜0.01）。结论与正常人群比较,OSAHS患者泪膜稳定性较低,睑板腺萎缩及腺体的形态异常发生率较高,并且睑板腺的形态改变与OSAHS严重程度有关。     

阻塞型睑板腺功能障碍患者睑板腺的形态学观察

背景 阻塞型睑板腺功能障碍(OMGD)是睑板腺功能障碍的常见类型,目前认为OMGD是由于睑板腺导管的阻塞和/或睑脂分泌异常导致,因此睑板腺形态学的改变具有重要的临床意义. 目的 运用Keratograph 5M眼表综合分析仪观察OMGD患者睑板腺的形态学改变并对其进行分析. 方法 采用前瞻性病例观察研究方法.纳入2015年1-6月在天津医科大学眼科医院确诊的OMGD患者60例60眼,同时选择60名健康体检者作为正常对照组.分别对2个组受检者进行眼表疾病指数(OSDI)问卷调查、泪膜破裂时间(BUT)、Keratograph 5M眼表综合分析仪观察睑板腺缺失情况、睑板腺开口评分及睑脂评分.根据OSDI评分分为轻度OMGD组(12.0＜ OSDI≤22.0) 23例、中度OMGD组(22.0＜OSDI≤32.0)21例和重度OMGD组(32.0＜OSDI≤100.0) 16例.分别对3个组患者的睑板腺状况进行评估与分析. 结果 OMGD组OSDI评分、睑板腺缺失评分及睑脂评分均高于正常对照组,与正常对照组比较,差异均有统计学意义(Z=-9.425、-7.781、-8.954,均P＜0.05).OMGD组和正常对照组BUT分别为(6.10±1.91)s和(10.67±2.11)s,睑板腺开口评分分别为1.35±0.90和0.88 ±0.64,差异均有统计学意义(t=-12.418、3.276,均P＜0.05).轻度OMGD组、中度OMGD组和重度OMGD组间OSDI、睑板腺缺失评分及睑脂评分比较,差异均有统计学意义(H=52.121、37.180、13.642,均P＜0.05),BUT、睑板腺开口评分差异均有统计学意义(F=58.191、8.474,均P＜0.05).OSDI与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间均呈正相关(r=0.708,P=0.000;r=0.759,P=0.000;r=0.270,P=0.003).BUT与睑板腺缺失评分、睑脂评分及睑板腺开口评分之间呈负相关(r=-0.692,P=0.000;r=-0.691,P=0.000;r=-0.192,P=0.036). 结论 Keratograph 5M眼表综合分析仪可以快速、精确地对睑板腺进行形态学观察.OMGD患者在眼表及睑板腺等方面与正常人存在差异.     

Enhanced secretory group II PLA2 activity in the tears of chronic blepharitis patients.

PURPOSE: Phospholipase A2 (PLA2) hydrolyzes phospholipids, one of the important constituents of human meibomian gland secretions. This study was performed to investigate PLA2 type and activity in the tears of chronic blepharitis patients compared to those of normal persons. METHODS: Tear samples of 36 patients and 10 normal persons were collected in non-heparinized microcapillary tubes. PLA2 activity in the tears was measured by Dole's method, and the results of the blepharitis patients were compared to those of the normal persons. The characterization of PLA2 was performed by the head group preference test and the dithiothreitol (DTT) sensitivity test. The classification of PLA2 type was done using Western blot analysis with anti-human secretory PLA2 antibody. RESULTS: No statistically significant differences were found among the six categories of chronic blepharitis. However, the mean PLA2 activity in the tears of the chronic blepharitis patients was about two times higher than that of the normal controls with statistical significance (P < 0.05). The PLA2 substrate specificity test revealed group II PLA2 activity. Furthermore, the group II PLA2 was identified as a 14 kDa band in Western blot analysis using an antibody raised against human secretory group II PLA2. CONCLUSIONS: Secretory group II PLA2 activity was significantly enhanced in the tears of the chronic blepharitis patients compared with that of the normal controls. It is suggested that this increased enzymatic activity may decrease the tear film stability through increased hydrolysis of phospholipids.     

Meibomian gland dropout is associated with immunodeficiency at HIV diagnosis: Implications for dry eye disease

AimTo characterize anterior eye health and tear film characteristics in individuals with human immunodeficiency virus (HIV) undergoing anti-retroviral therapy.MethodsThis cross-sectional study involved 35 adults, categorized as healthy controls (n = 18) or as HIV-positive patients (n = 17), with no history of opportunistic infection or current ocular fundus abnormalities. Participants underwent a comprehensive anterior eye assessment. Primary outcome measures were dry eye symptoms (Ocular Surface Disease Index survey), tear film osmolarity, and extent of meibomian gland dropout. Secondary outcomes measures were ocular redness, tear film stability, and ocular surface staining. Levels of 36 cytokines were assayed from basal tears using a multiplex bead array.ResultsThe HIV-positive group showed more extensive meibomian gland dropout relative to controls (mean ± SD, controls: 29.6 ± 5.8 versus 37.0 ± 13.9%, p = 0.045). The extent of meibomian gland dropout was negatively correlated with blood CD4 T-cell count (a marker of immunodeficiency) at diagnosis (r = −0.69, p = 0.006). All other tests of anterior ocular health, including dry eye symptom levels, were not significantly different between the groups. There were no significant inter-group differences for the 36 cytokines assayed in the tear film.ConclusionsWe find greater meibomian gland dropout in HIV-positive individuals that is related to disease severity at diagnosis. Given this feature predisposes to dry eye disease, it suggests the need for long-term studies of anterior eye health in people with HIV.     

LAISK术后蠕形螨感染对眼表损伤的临床研究

目的 探讨准分子激光原位角膜磨镶术（laser-assisted in situ keratomileusis,LASIK）术后蠕形螨感染患者的眼表特征。设计 回顾性病例系列。研究对象2017年9月至2018年5月在北京同仁医院就诊的56例螨虫性睑缘炎患者,分为LASIK术后组（9例）和对照组（47例）。方法 采用Keratograph5M眼表综合分析仪和泪液分泌试纸对两组患者进行眼表检查,包括角膜荧光染色（cornea fluorescein staining,FL）,泪膜破裂时间（tear film break-up time, TBUT）,眼红分析（conjunctival hyperemia index, CHI）,睑板腺照相和泪液分泌试验（Schirmer I test, SIt）。主要指标  FL评分,非侵入式TBUT,结膜眼红指数,睑板腺评分和基础泪液分泌量。结果  LASIK术后组的FL评分（1.3±1.0）明显高于对照组（0.38±0.15）（P＜0.01）;而LASIK术后组 TBUT（10.55±5.8）s,CHI（1.7±0.5）,SIt（16.4±3.8）mm,睑板腺评分（1.42±1.0）与对照组TBUT（9.93±5.3）s,CHI（1.74±0.67）,SIt（14.0±11.2）mm,睑板腺评分（1.45±1.03）相比差异无统计学意义（P均＞0.05）。结论 LASIK术后的患者发生螨虫性睑缘炎更容易继发角膜上皮点状病变,加重眼表损伤。     

慢性睑缘炎与蒸发过强性干眼症的临床观察

目的探讨慢性睑缘炎与蒸发过强性干眼的关系。方法选择2002年11月至2003年4月北京同仁眼科中心门诊诊断为慢性睑缘炎患者4l例（82只眼）,其中男性22例、女性19例,观察其外眼情况,进行泪液分泌试验（SchirmerⅠtest,ST）、泪膜破裂时间（BUT）检测、泪液镜分析以及睑板腺分泌物的细菌学和药敏试验。选择同期门诊青光眼、白内障、准分子激光原位角膜磨镶术术前检查的患者30例（60只眼）设为对照组,其中男性16例、女性14例,对其睑板腺分泌物进行细菌培养和药敏试验,并且对比两组细菌种类和药敏情况。结果41例（82只眼）慢性睑缘炎患者中,30只眼（36.6％）ST〈10mm,56只眼（68．3％）BUT〈10s,46只眼（56．1％）泪液镜分级3级以上。两组睑板腺分泌物中培养出表皮葡萄球菌、金黄色葡萄球菌及棒状杆菌。两组细菌阳性率和金黄色葡萄球菌阳性率比较,差异有统计学意义（P〈0.05）。两组表皮葡萄球菌和棒状杆菌药物敏感性比较,差异有统计学意义（P〈0.05）。结论慢性睑缘炎是导致蒸发过强性干眼的重要病因之一。     

Tear film lipid layer thickness measurement from Ocular Surface Analyzer as a marker to monitor treatment of meibomian gland dysfunction in a study comparing physiological detergent-free eyelid wipes with conventional therapy: A randomized trial

Purpose:To compare the efficacy of physiological, non-detergent eyelid wipes with conventional lid hygiene in patients with meibomian gland dysfunction (MGD).Methods:Fifty participants with MGD were recruited and randomized into two groups. Participants in group I used Evolve Pure™ Eyewipes twice a day to clean the eyelid debris along with standard therapy (antibiotic and lubricants) and participants in group II followed lid hygiene with warm compresses along with standard therapy. Symptoms, ocular surface assessment (lipid layer thickness, tear meniscus height, non-invasive tear film breakup time, and meibography), slit-lamp biomicroscopy (eyelash contamination, meibomian gland blockage, meibomian gland secretion, and meibomian gland telangiectasia) and tear film osmolarity were noted at baseline and 90 days after therapy.Results:Significant improvement in symptoms and signs of MGD was observed in both groups after treatment (P < 0.001); however, the clinical improvement was better with the use of eyelid wipes. Lipid layer thickness increased significantly in group I (P = 0.0006) and group II (P = 0.0002), which was maintained even after adjusting for sociodemographic variables such as age, sex, and severity score of symptoms and signs.Conclusion:Lipid layer thickness of the tear film is a sensitive marker in monitoring response to treatment in patients with MGD. The use of physiological detergent-free eyelid wipes is non-inferior to lid hygiene and warm compresses, which remains the mainstay for treatment of MGD; the clinical improvement with eyelid wipes was noted to be better.     

Meibography: A review of techniques and technologies

Meibomian glands play a significant role in tear production by contributing lipids to the superficial tear film.¹ Dysfunction of the meibomian glands destabilizes tears resulting in evaporative dry eye.2, 3 Historically, the meibomian glands were assessed in an ex vivo fashion through histologic studies. However, innovations in ocular imaging have advanced significantly in recent decades to include meibography. Meibography is an imaging study developed 35 years ago exclusively for the purpose of observing the morphology of meibomian glands in vivo.4, 5 In this review of meibography, we briefly describe the etiology of meibomian gland dysfunction and then discuss various meibography techniques, technologies, and methods of image analysis. We close with a review of the literature, crediting various studies for the significant contributions made toward our current understanding of the meibomian glands.