Meibomian Gland Dropout in Patients with Dry Eye Disease in China

Purpose: To examine the morphological changes in the meibomian glands of eyes of patients with dry eye disease using the non-contact infrared meibography system and to assess their relationship with meibomian dropout, signs, and tear-film function. Methods: Subjects included 264 randomly selected patients (528 eyes) suffering from dry eye disease (95 males, 169 females; age range, 7-85 years; mean male age, 39.83 +/- 19.17 years; mean female age, 46.16 +/- 17.38 years). Tear-film break-up time (BUT) was measured and tear-film production was evaluated by the Schirmer test I (SIT). Subjective symptoms were also scored. The upper and lower eyelids were turned over, and the meibomian glands were observed using the non-contact meibography system. Partial or complete loss of the meibomian glands (meibomian dropout) was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area was >2/3 of the total meibomian gland area). Results: The average SIT result was 6.71 +/- 6.13 mm (range 0-30 mm) and that for BUT was 3.13 +/- 2.39 s (range 0-10 s). The average fluorescein staining score was 4.25 +/- 4.05 (range 0-12). In addition, the mean meibomian gland photographic score was 4.35 +/- 1.39. The correlation between the meibomian gland photographic scores and various ocular surface examinations were evaluated using Kendall's correlation. SIT and BUT were significantly negatively correlated with the meibomian gland photographic score, whereas corneal fluorescein staining was positively correlated. Conclusions: The results suggest a large proportion of meibomian dropout cases among patients with dry eye disease, indicating that treatment targeted at the meibomian gland will become an important direction for treating dry eye disease. Meibography is recommended as a routine test for dry eye disease.