Korean J Ophthalmol.  2019 Jun;33(3):205-213. 10.3341/kjo.2018.0104.

Distribution and Characteristics of Meibomian Gland Dysfunction Subtypes: A Multicenter Study in South Korea

Affiliations
  • 1Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. crisim@korea.ac.kr
  • 2Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sara514@catholic.ac.kr
  • 3Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea.
  • 4Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 5Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea.
METHODS
One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded.
RESULTS
The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, p < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid.
CONCLUSIONS
The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.

Keyword

Classification; Diagnosis; Meibomian gland dysfunction; Meibomian glands; Therapeutics

MeSH Terms

Classification
Diagnosis
Eyelids
Humans
Hygiene
Korea*
Meibomian Glands*

Figure

  • Fig. 1 Absolute frequency of treatment modalities for patients with meibomian gland dysfunction. HA = hyaluronic acid eye drops; CMC = carboxymethylcellulose eye drops.

  • Fig. 2 Absolute frequency of treatment modalities for patients with meibomian gland dysfunction according to the subtype of the upper eyelid. HA = hyaluronic acid eye drops; CMC = carboxymethylcellulose eye drops. *p-value of less than 0.05.

  • Fig. 3 Absolute frequency of treatment modalities for patients with meibomian gland dysfunction according to the subtype of the lower eyelid. HA = hyaluronic acid eye drops; CMC = carboxymethylcellulose eye drops. *p-value of less than 0.05.


Reference

1. Korb DR, Henriquez AS. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980; 51:243–251.
2. Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011; 52:1930–1937.
Article
3. Kim HM, Eom Y, Song JS. The relationship between morphology and function of the meibomian glands. Eye Contact Lens. 2018; 44:1–5.
Article
4. Sirigu P, Shen RL, Pinto da Silva P. Human meibomian glands: the ultrastructure of acinar cells as viewed by thin section and freeze-fracture transmission electron microscopies. Invest Ophthalmol Vis Sci. 1992; 33:2284–2292.
5. Driver PJ, Lemp MA. Meibomian gland dysfunction. Surv Ophthalmol. 1996; 40:343–367.
Article
6. Jester JV, Nicolaides N, Smith RE. Meibomian gland studies: histologic and ultrastructural investigations. Invest Ophthalmol Vis Sci. 1981; 20:537–547.
7. Kozak I, Bron AJ, Kucharova K, et al. Morphologic and volumetric studies of the meibomian glands in elderly human eyelids. Cornea. 2007; 26:610–614.
Article
8. Seifert P, Spitznas M. Immunocytochemical and ultrastructural evaluation of the distribution of nervous tissue and neuropeptides in the meibomian gland. Graefes Arch Clin Exp Ophthalmol. 1996; 234:648–656.
Article
9. McCulley JP, Sciallis GF. Meibomian keratoconjunctivitis. Am J Ophthalmol. 1977; 84:788–793.
Article
10. Viso E, Rodriguez-Ares MT, Abelenda D, et al. Prevalence of asymptomatic and symptomatic meibomian gland dysfunction in the general population of Spain. Invest Ophthalmol Vis Sci. 2012; 53:2601–2606.
Article
11. Amano S, Inoue K. Estimation of prevalence of meibomian gland dysfunction in Japan. Cornea. 2017; 36:684–688.
Article
12. Amano S, Inoue K. Clinic-based study on meibomian gland dysfunction in Japan. Invest Ophthalmol Vis Sci. 2017; 58:1283–1287.
Article
13. Alghamdi YA, Mercado C, McClellan AL, et al. Epidemiology of meibomian gland dysfunction in an elderly population. Cornea. 2016; 35:731–735.
Article
14. Siak JJ, Tong L, Wong WL, et al. Prevalence and risk factors of meibomian gland dysfunction: the Singapore Malay Eye Study. Cornea. 2012; 31:1223–1228.
15. Lekhanont K, Rojanaporn D, Chuck RS, Vongthongsri A. Prevalence of dry eye in Bangkok, Thailand. Cornea. 2006; 25:1162–1167.
Article
16. Lin PY, Cheng CY, Hsu WM, et al. Association between symptoms and signs of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study. Invest Ophthalmol Vis Sci. 2005; 46:1593–1598.
Article
17. Blackie CA, Korb DR, Knop E, et al. Nonobvious obstructive meibomian gland dysfunction. Cornea. 2010; 29:1333–1345.
Article
18. Shimazaki J, Goto E, Ono M, et al. Meibomian gland dysfunction in patients with Sjogren syndrome. Ophthalmology. 1998; 105:1485–1488.
19. Foulks GN, Bron AJ. Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading. Ocul Surf. 2003; 1:107–126.
Article
20. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011; 52:1922–1929.
Article
21. Eom Y, Lee JS, Kang SY, et al. Correlation between quantitative measurements of tear film lipid layer thickness and meibomian gland loss in patients with obstructive meibomian gland dysfunction and normal controls. Am J Ophthalmol. 2013; 155:1104–1110.
Article
22. Eom Y, Lee JS, Keun Lee H, et al. Comparison of conjunctival staining between lissamine green and yellow filtered fluorescein sodium. Can J Ophthalmol. 2015; 50:273–277.
Article
23. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003; 22:640–650.
Article
24. Duke-Elder WS, MacFaul PA. The ocular adnexa. Part II. Diseases of the eyelids. In : Duke-Elder WS, MacFaul PA, editors. System of ophthalmology. Vol. XIII. London: H. Kimpton;1974. p. 241.
25. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:75–92.
26. Lemp MA. Advances in understanding and managing dry eye disease. Am J Ophthalmol. 2008; 146:350–356.
Article
27. Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf. 2004; 2:149–165.
Article
28. Eom Y, Choi KE, Kang SY, et al. Comparison of meibomian gland loss and expressed meibum grade between the upper and lower eyelids in patients with obstructive meibomian gland dysfunction. Cornea. 2014; 33:448–452.
Article
29. Goto E, Shimazaki J, Monden Y, et al. Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction. Ophthalmology. 2002; 109:2030–2035.
Article
30. Korb DR, Greiner JV, Glonek T, et al. Effect of periocular humidity on the tear film lipid layer. Cornea. 1996; 15:129–134.
Article
31. Arita R, Morishige N, Koh S, et al. Increased tear fluid production as a compensatory response to meibomian gland loss: a multicenter cross-sectional study. Ophthalmology. 2015; 122:925–933.
32. Dougherty JM, McCulley JP. Analysis of the free fatty acid component of meibomian secretions in chronic blepharitis. Invest Ophthalmol Vis Sci. 1986; 27:52–56.
33. Craig JP, Wang MT, Kim D, Lee JM. Exploring the predisposition of the Asian eye to development of dry eye. Ocul Surf. 2016; 14:385–392.
34. Wan T, Jin X, Lin L, et al. Incomplete blinking may attribute to the development of meibomian gland dysfunction. Curr Eye Res. 2016; 41:179–185.
Article
35. Jung JW, Park SY, Kim JS, et al. Analysis of factors associated with the tear film lipid layer thickness in normal eyes and patients with dry eye syndrome. Invest Ophthalmol Vis Sci. 2016; 57:4076–4083.
Article
36. Song JY, Kim MH, Paik JS, et al. Association between menstrual irregularity and dry eye disease: a population-based study. Cornea. 2016; 35:193–198.
37. Na KS, Jee DH, Han K, et al. The ocular benefits of estrogen replacement therapy: a population-based study in postmenopausal Korean women. PLoS One. 2014; 9:e106473.
Article
38. Sullivan DA, Sullivan BD, Evans JE, et al. Androgen deficiency, meibomian gland dysfunction and evaporative dry eye. Ann N Y Acad Sci. 2002; 966:211–222.
Article
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