Association of Epitheliopathy of Upper and Lower Eyelid Marginal Conjunctiva With Meibomian Gland Dysfunction and Symptoms of Dry-Eye Disease
Narrative Responses:
Purpose
To determine if there is an association between meibomian gland dysfunction (MGD) and epitheliopathy of the marginal conjunctiva of the upper and lower eyelids in patients with evaporative dry eye disease.
Methods
Biomicroscopic examination of the eyelid margins of patients (n=23;46 eyes) diagnosed with MGD was performed following vital staining with sodium fluorescein (SF) and Lissamine green (LG). Examination was focused on the area postjacent to the line of Marx in the upper and lower eyelids. Inclusion criteria: meibomian gland analysis (MGA) score ≤12, SPEED questionnaire score >6. Patients were compared to controls (n=20;40 eyes) without signs or symptoms of dry eye disease. Staining was graded on a scale of 1 (mild), 2 (moderate), and 3 (severe) in each of 3 equidistant zones (nasal, central, and temporal).
Results
Average overall staining was greater in the lower eyelid 0.49±0.4 compared to the upper eyelid 0.30±0.3 (P<0.01). The average staining scores in the upper eyelid margin were 0.45±0.6 (nasal), 0.30±0.5 (central), and 0.13±0.4 (temporal) and in the lower eyelid were 0.72±0.8 (nasal), 0.28±0.6 (central), and 0.45±0.6 (temporal). Staining was greatest in the nasal zone in the upper eyelid compared to central (P<0.01) and temporal zones (P<0.001) and similarly in the lower eyelid the nasal zone had the greatest staining compared to central (P<0.01) and temporal zones (P<0.01). Staining scores compared to control eyes were significantly different (P<0.001).
Conclusion
Dry eye disease secondary to moderate to severe MGD is associated with epitheliopathy of the marginal conjunctiva of both the upper and lower eyelids. Interestingly, the greatest staining occurred in the nasal zone of both eyelids, regions reportedly housing relatively greater numbers of functional meibomian glands in dry eye conditions.