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Background: Blepharitis is a chronic inflammatory condition of the eyelids that affects a large proportion of patients in eye care settings. First-line treatments provide only partial relief for many patients. The BlephEx™ device provides automated eyelid debridement and aims to remove pathogenic biofilms from the eyelid margin to treat blepharitis long-term. However, evidence supporting the efficacy of BlephEx™ is limited. Methods: In this double-masked randomized controlled trial, 42 patients with symptomatic blepharitis refractory to treatment were assigned to the BlephEx™ treatment or sham treatment group. Outcome measures including Ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer test, and Efron grading scale scores were assessed at baseline and after 4 weeks. A crossover design in which the treatment groups were swapped after 4 weeks was used as a recruitment tool. After receiving treatment, two patients (one per group) were lost to follow-up. Results: The sham group exhibited a significant decrease in the Efron Grading Scale score. No significant differences were observed in the other outcomes between the two groups. The BlephEx™ group showed slightly greater decreases in the OSDI and Efron grading scale scores and an increase in the TBUT than did the sham group, but these differences were not statistically significant. Mild discomfort was the most common side effect and occurred equally in both groups. Conclusions: No significant difference in outcomes was observed between patients who underwent BlephEx™ therapy and those who received sham treatment. BlephEx™ treatment cannot be recommended for treating blepharitis. Trial registration: Retrospectively registered on February 16, 2024 in the DRKS (German Clinical Trials Register under https://drks.de/search/de/trial/DRKS00033492) under the trial registration number DRKS00033492. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the correlation between insulin-like growth factor 1 (IGF-1) and ocular surface parameters in obese prepubertal boys. Thirty obese prepubertal boys and 30 age- and gender-matched healthy controls underwent physical measurements, laboratory tests, and ocular surface assessments. The obese group showed lower IGF-1 levels (P = 0.001), reduced Schirmer I tear test (SIT) (P <0.001), and higher meibomian gland scores (meiboscore) compared to controls (P = 0.015). Bivariate analysis revealed a positive association between IGF-1 and SIT (r = 0.677, P < 0.001), and a negative association with between IGF-1 and meiboscore (r = − 0.487, P < 0.001). Multiple regression analysis indicated that IGF-1 (P < 0.001) and triglycerides (P = 0.028) independently influenced SIT. Logistic analysis showed a significant association between decreased IGF-1 and higher meiboscore values (OR 0.994, 95% confidence interval 0.988–1.000; P = 0.033). Conclusion: The findings suggest that reduced IGF-1 in obese prepubertal boys is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors. This implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on. What is Known: • Obese children exhibit decreased levels of IGF-1, and this reduction in IGF-1 is associated with cardiovascular metabolic complications related to obesity. • Ocular surface tissues might act as targets for hormones, might experience local effects of these hormone. What is New: • In prepubertal obese boys, the decrease in IGF-1 is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors.• This finding implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on. [ABSTRACT FROM AUTHOR]

Meibomian gland dysfunction (MGD) is increasingly recognized as a critical contributor to evaporative dry eye, significantly impacting visual quality. With a global prevalence estimated at 35.8 %, it presents substantial challenges for clinicians. Conventional manual evaluation techniques for MGD face limitations characterized by inefficiencies, high subjectivity, limited big data processing capabilities, and a dearth of quantitative analytical tools. With rapidly advancing artificial intelligence (AI) techniques revolutionizing ophthalmology, studies are now leveraging sophisticated AI methodologies--including computer vision, unsupervised learning, and supervised learning--to facilitate comprehensive analyses of meibomian gland (MG) evaluations. These evaluations employ various techniques, including slit lamp examination, infrared imaging, confocal microscopy, and optical coherence tomography. This paradigm shift promises enhanced accuracy and consistency in disease evaluation and severity classification. While AI has achieved preliminary strides in meibomian gland evaluation, ongoing advancements in system development and clinical validation are imperative. We review the evolution of MG evaluation, juxtapose AI-driven methods with traditional approaches, elucidate the specific roles of diverse AI technologies, and explore their practical applications using various evaluation techniques. Moreover, we delve into critical considerations for the clinical deployment of AI technologies and envisages future prospects, providing novel insights into MG evaluation and fostering technological and clinical progress in this arena. [ABSTRACT FROM AUTHOR]

Purpose: Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO). Methods: This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for "unresponsiveness" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model's discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis. Results: The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73–0.91), affirming the model's consistent and reliable ability to distinguish between responsive and non-responsive TAO patients. Conclusion: Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to investigate changes in tear function, meibomian glands and corneal endothelium in patients receiving systemic isotretinoin therapy. Materials and methods: This prospective study included 38 eyes from 38 patients (23 females and 15 males) treated with systemic isotretinoin (0.5–1 mg/kg/day) following the diagnosis of acne vulgaris. All patients underwent a comprehensive ophthalmologic examination at baseline, 1st month, and third month of treatment. Subjective complaints were assessed using the Ocular Surface Disease Index (OSDI). Tear functions were evaluated through non-invasive tear break up time (NIBUT) and Schirmer I test. Meibomian gland (MG) changes were examined using meibography. Corneal parameters, including endothelial cell density (ECD), coefficient of variation (CV), the number of cells with a hexagonal shape (6A), average cell area (AVG), and central corneal thickness (CCT) were assessed using non-contact specular microscopy. Results: The mean age of the patients was 19.29 ± 2.83 years. Ocular surface-related discomfort, measured with OSDI scores, significantly worsened at the third month measurements compared to the pre-treatment values (p < 0.001). In the 1st month of treatment, there was a significant decrease in NIBUT (p < 0.05). No statistically significant difference was found in the Schirmer test results at each visit. According to the 1st and third-month analysis, there was a significant increase in MG loss compared to the pre-treatment period (p < 0.001). ECD, CV, 6 A, AVG measurements at the first and third months showed a significant change compared to the pre-treatment values (p < 0.001). No significant difference was observed in the CCT measurements during the treatment. Conclusion: Systemic isotretinoin disrupted tear stability, caused MG loss, deterioration in corneal endothelium, and led to symptomatic complaints in patients. [ABSTRACT FROM AUTHOR]

Background: Diabetes, as the most common disease caused by metabolic disorders, is associated with several compli-cations, including ocular complications. The aim of this cross-sectional study was to determine the fre-quency of meibomian gland dysfunction and dry eye in patients with diabetes. Materials and Methods: In this descriptive-analytical cross-sectional study, patients with type 2 diabetes referred to the eye clinic of Farshchian Hospital (Sina) from December 2019 to October 2020 were included. Data were collected on the patients’ demographic characteristics, duration of diabetes, and HbA1c using a pre-designed checklist. The severity of dry eye was assessed by the tear breakup time (TBUT) test, while meibomian gland disorder and ocular complications were evaluated by a slit lamp. Results: In this study, 267 patients with type 2 diabetes participated. The mean age of the patients was 59.8 years, and 44.2% of them were male. Mild, moderate, and severe dry eye were observed in 34.1%, 18.0% and 5.2% of the patients, respectively. Grades 1, 2, and 3 of meibomian gland dysfunction were observed in 32.6%, 15.7%, and 5.2% of the patients respectively. Patients with poor glycemic control had higher se-verity of dry eye (p

Abstract Meibomian Gland Dysfunction (MGD) and Dry Eye Disease (DED) comprise two of the most significant eye diseases, impacting millions of sufferers worldwide. Several etiological factors influence the early symptoms of DED. Early diagnosis and treatment of erectile dysfunction may significantly improve the Quality of Life (QoL) for people. The current study introduces the ESAE-ODNN, an improved stacked autoencoder-aided optimised deep neural network, as a new way to predict DED using feature selection (FS), feature extraction (FE), and classification. The approach described here is novel because it merges chaotic maps into FS, employs SLSTM-STSA for improved classification accuracy (CA), and optimizes with the adaptive quantum rotation of the Enhanced Quantum Bacterial Foraging Optimisation Algorithm (EQBFOA). The present study enhances prediction functions by extracting MGD-related features and complicated relationships from the DED dataset. To ensure essential feature identification, the ESAE minimizes irrelevant and redundant features. To predict the DED, the ESAE first applies FE and then implements an ODNN classifier. This method fine-tunes the ODNN framework to enhance the effectiveness of the classification. The proposed ESAE-ODNN classification system efficiently assists in the early diagnosis of DED. Combining advanced Deep Learning (DL) methods with optimization can help us understand MGD features better and sort the data with the best accuracy (96.34%). The experimental evaluation with relevant performance metrics indicates that the proposed method is efficient in diverse aspects: accurate identification, reduced complexity, and fine-tuned performance. The ESAE-ODNN’s robustness in handling intricate feature indications and high-dimensional data outperforms the existing state-of-the-art techniques.

AIM: To study the effect of intense pulsed light(IPL)combined with meibomian gland massage on postoperative dry eye in cataract patients with meibomian gland dysfunction(MGD).METHODS: A retrospective analysis was conducted on the general data of 100 patients(100 eyes)with cataract and postoperative dry eye syndrome accompanied by MGD treated in our hospital from June 2022 to June 2023. They were divided into a control group(n=50)and an observation group(n=50)according to different treatment methods, and received meibomian gland massage and meibomian gland massage combined with IPL treatment, respectively. The tear film break-up time(BUT), Schirmer I test(S I t), meibomian gland secretion score, ocular surface disease index(OSDI), ocular staining score(OSS), and treatment efficacy of the two groups of patients were compared before treatment and at 1 wk and 1 and 3 mo after treatment.RESULTS: The BUT and SIt in both groups after treatment were higher than those before treatment, while the secretion of meibomian gland, OSS score, and OSDI score were lower than those before treatment(all P

Balamurali Vasudevan, Kevin Helmuth, Robert E Fintelmann Arizona College of Optometry, Midwestern University, Glendale, AZ, USACorrespondence: Balamurali Vasudevan, Email bvasud@midwestern.eduPurpose: The aim of the current study was to investigate the efficacy of Thermal pulsation treatment, completed one month prior to cataract surgery, as a means of eliminating or significantly mitigating the exacerbating effects of cataract surgery on dry eye patients.Setting: Glendale, Arizona.Design: Prospective, longitudinal, non-masked, randomized clinical investigation.Methods: The treatment group received Thermal pulsation therapy approximately 1 month prior to undergoing immediate sequential, same-day bilateral cataract surgery. The control group did not receive pre-operative Thermal pulsation but had cataract surgery performed in the same way, approximately 1 month after their baseline visit. Subjective questionnaires and objective clinical findings were evaluated at baseline, 1, 3, and 6 months after cataract surgery in the treatment group and control group.Results: A total of 62 patients were randomized into two groups of 31 representing 124 eyes. Subjective improvement was observed in the treatment group with OSDI and SPEED II scores. Mean (SD) of the OSDI improved significantly (p< 0.01) from 56.98 (18.30) from visit 1 to 14.73 (12.22) at visit 4, and the mean (SD) of the SPEED II scores improved significantly (p=0.01) from 13.84 (6.12) during visit 1 to 7.1 (5.00) at visit 4 in the treatment group.Conclusion: Pre-operative Thermal pulsation treatment in patients with dry eye secondary to MGD appears to reduce dry eye symptoms after cataract surgery. Expectations should be moderated by the fact that the reduction in symptoms appears to reduce prior to 3 months post-op after cataract surgery.Keywords: lipiflow (thermal pulsation), dry eye, meibomian gland, cataract surgery, inflammatory cytokines

The aim of the study was to investigate the expression levels of ACE2 in ocular glands and to investigate the effect of S protein on them. Male C57BL/6J mice were used for the experiments. The expression levels of ACE2 are highest in the Meibomian glands, followed by the conjunctiva, the cornea, and the lacrimal glands. Co-immunoprecipitation assays confirmed direct binding between ACE2 and S protein in ocular surface epithelia and Meibomian glands. CD45+ cell infiltration was found in the S protein treatment group, which was accompanied by upregulation of inflammation-related cytokines. There was also prominent cell apoptosis in the S protein treatment group. In conclusion, not only the cornea and the conjunctiva, but also the Meibomian glands express ACE2, and S protein could induce ocular surface epithelial cell and Meibomian gland cell inflammation and apoptosis. [ABSTRACT FROM AUTHOR]

Microbiota present around the ocular surface, encompassing the eyelid skin, the conjunctival sac, and the meibomian glands, play a significant role in various inflammatory conditions associated with the ocular surface. Cutibacterium acnes (C. acnes), formerly, Propionibacterium acnes, is one of the most predominant commensal bacteria and its relative abundance declines with aging. However, it can act as both an infectious and an immunogenic pathogen. As an infectious pathogen, C. acnes has been reported to cause late onset endophthalmitis post-cataract surgery and infectious keratitis. On the other hand, it can trigger immune responses resulting in conditions such as phlyctenules in the cornea, chalazion in the meibomian glands, and granuloma formation in ocular sarcoidosis. This review explores the role of C. acnes in ocular inflammation, specifically highlighting its implications for diagnosis and management. [ABSTRACT FROM AUTHOR]

Evaluating how Meibomian glands can change in appearance has the potential to advance the understanding of Meibomian gland health and may lead to enhanced diagnosis and therapy. This work aimed to investigate Meibomian gland appearance after therapeutic Meibomian gland expression. Fifteen subjects attended three study visits over a two-week period. Meibography was performed before and after therapeutic Meibomian gland expression, the following day, and 2 weeks after expression. Six central glands were used to calculate Meibomian gland morphological parameters such as gland length ratio, gland width, gland area, gland tortuosity, and gland contrast. A custom semi-automated image analysis software was used to calculate Meibomian gland metrics. Furthermore, a high-resolution imaging system was developed to capture clear images of the Meibomian glands, free of any artefacts, which were used for precise calculations of Meibomian gland contrast. The expression procedure had a significant impact on Meibomian gland contrast and length ratio immediately afterwards. The least square mean difference (95% CI) from baseline for Michelson contrast was −0.006 (−0.010, −0.001) and −1.048 (−2.063, −0.033) for simple contrast. The least square mean ratio of the gland length ratio immediately after the expression to baseline was 0.758 (0.618, 0.931). Following therapeutic expression, Meibomian glands exhibit reduced brightness and length. However, within 24 h, they appear to recover and return to their baseline state, indicating a relatively short recovery time. This sheds light on whether meibography is solely focused on capturing gland structure or if it also captures acinar activity. The hyperreflective properties of lipids suggest that the decrease in contrast observed after expression could be attributed to a reduction in the visualisation of acini activity. A decrease in Meibomian gland length ratio implies that the loss of gland structure following treatment may be indicative of a temporary structural alteration. [ABSTRACT FROM AUTHOR]

Meibomian glands (MGs) secrete lipid (meibum) onto the ocular surface to form the outermost layer of the tear film. Proper meibum secretion is essential for stabilizing the tear film, reducing aqueous tear evaporation, and maintaining the homeostasis of the ocular surface. Atrophy of MG as occurs with aging, leads to reduction of meibum secretion, loss of ocular surface homeostasis and evaporative dry eye disease (EDED). Since MGs are holocrine glands, secretion of meibum requires continuous self-renewal of lipid-secreting acinar meibocytes by stem/progenitor cells, whose proliferative potential is dramatically reduced with age leading to MG atrophy and an age-related meibomian gland dysfunction (ARMGD). Understanding the cellular and molecular mechanisms regulating meibocyte stem/progenitor cell maintenance and renewal may provide novel approaches to regenerating MG and treating EDED. Towards that end, recent label retaining cell and lineage-tracing experiments as well as knock-out transgenic mouse studies have begun to identify the location and identities of meibocyte progenitor cells and potential growth and transcription factors that may regulate meibocyte renewal. In addition, recent reports have shown that ARMGD may be reversed by novel therapeutics in mice. Herein, we discuss our current understanding of meibocyte stem/progenitor cells and the hunt for gland renewal.

Management of chalazion, characterized by noninfectious chronic granulomatous inflammation of the meibomian glands (MGs), remains challenging in ophthalmic practice, particularly because of its propensity for recurrence even after surgical intervention. This study aimed to evaluate the combined efficacy of doxycycline and intense pulsed light (IPL) therapy for treating intractable recurrent chalazion, focusing on reducing recurrence rates and improving MG status. This retrospective study included patients with intractable recurrent chalazion refractory to conventional treatments including surgical intervention and antibiotics. All patients were treated with a combination of doxycycline and IPL therapy. Clinical assessments included best-corrected visual activity, intraocular pressure, and MG evaluations using slit-lamp biomicroscopy and Keratograph 5 M topography. The study included 12 patients (5 male and 7 female) with an average age of 36.3 years. Treatment outcomes were categorized as ‘success’ (83.3%), ‘stationary’ (8.3%), and ‘failure’ (8.3%). Significant improvements were noted in the MG expression scores (p = 0.038), MG quality scores (p = 0.045), and lid margin telangiectasia scores (p = 0.002). In addition, significant improvement in meiboscores was observed (p = 0.002). The combination of doxycycline and IPL therapy demonstrated promising efficacy in treating intractable recurrent chalazion, with significant improvements in MG function and reduced recurrence rates. This treatment approach offers a viable alternative for patients with recurrent chalazions, particularly for those who are unresponsive to conventional treatments.

Purpose: To report the ocular surface and meibomian gland changes in polycystic ovarian syndrome (PCOS) women taking hormone supplementation. Methods: Case series. Results: Three women (27 ± 11 years) already diagnosed with PCOS presented with dry eye symptoms (mean OSDI, 37.5) for a mean duration of 13 months and were taking hormonal supplements for a mean duration of 60 ± 11 months. The hormonal supplements included oral estrogen (n=3), oral progesterone (n=3), antiandrogen cyproterone (n=1) and isotretinoin (n=1). Ocular surface evaluation revealed mean NIBUT of 9.9 ± 1.6 seconds and mean TMH of 0.27 ± 0.05 mm, assessed non-invasively using Oculus keratograph 5M (K5M). Meibography (K5M) showed near total loss of all meibomian glands (n=8/12 eyelids) with residual ghost glands in all four eyelids of two patients, and gland shortening alone in one patient. The gland morphology did not change following intense thermal pulsation treatment or cessation of hormonal therapy. Conclusions: Near-total irreversible meibomian gland loss was seen in two young PCOS women taking hormonal supplements. Collaboration between ophthalmologists and gynecologists is advisable for early detection and better understanding of dry eye disease (DED) progression in these patients.

Purpose: The assessment of tear film and ocular surface conditions in patients with acquired immunodeficiency syndrome (AIDS) has been poorly studied thus far. We aim to assess tear film parameters, ocular surface characteristics, and dry eye disease (DED) symptoms of patients with AIDS who did not undergo highly active antiretroviral treatment (HAART). Methods: This case-control study included 154 age-, sex-, and ethnicity-matched healthy controls and patients with AIDS. All participants underwent comprehensive ocular surface assessment and subjective DED symptomology evaluation. Data were collected between March 2022 and July 2022. Results: HAART-naïve patients with AIDS had a shorter noninvasive tear film breakup time (median 3.76 vs. 8.54 s), thinner tear film lipid layer thickness (median 73.00 vs. 91.00 nm), and lower Schirmer I test values (median 5.00 mm/5 min vs. 12.00 mm/5 min) (all P < 0.001). Moreover, higher corneal fluorescein staining scores (median 1.00 vs. 0.00) and higher upper, lower, and total meibomian gland grades were observed in AIDS patients (all P < 0.05). Negative correlations between the blood viral load and the Ocular Surface Disease Index score (r = -3.50, P = 0.027) and the Schirmer I test score (r = -0.374, P = 0.017) were detected in patients with AIDS. Conclusion: Altered tear film status was observed in individuals with HAART-naïve AIDS, even when there were no other ocular symptoms present. Therefore, patients with AIDS should be encouraged to undergo comprehensive ocular surface examinations to detect any subclinical tear film alterations occurring. [ABSTRACT FROM AUTHOR]

Meibomian Glands (MG) are sebaceous glands responsible for the production of meibum, the main component of the Tear Film Lipid Layer (TFLL). The TFLL facilitates the spread of the tear film over the ocular surface, provides stability and reduces tear evaporation. Alterations in meibum composition lead to different ocular alterations like Meibomian Gland Dysfunction (MGD) and subsequent Evaporative Dry Eye (EDE). The aim of the present study was to investigate the composition and abundance of meibum lipids and their relationship with eyelid margin abnormalities, lipid layer patterns and MG status. The study utilizes a lipidomic approach to identify and quantify lipids in meibum samples using an Elute UHPLC system. This system considered all four dimensions (mass/charge, retention time, ion mobility and intensity) to provide the accurate identification of lipid species. Samples were categorized as healthy or low/no signs of alteration (group 1) or severe signs of alteration or EDE/MGD (group 2). The current investigation found differences in Variable Importance in Projection lipid abundance between both groups for the MGD signs studied. Changes in meibum composition occur and are related to higher scores in eyelid margin hyperaemia, eyelid margin irregularity, MG orifice plugging, MG loss and lipid layer pattern. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, increasing studies have focused on the abnormal proliferation and differentiation of acinous cells in the meibomian gland, suggesting that this process is closely related to the occurrence and development of dry eye. Structural and functional abnormalities such as blockage of the lumen of the meibomian gland and atrophy of the glands can cause or exacerbate dry eye. Therefore, the study of changes in the meibomian glands in dry eyes is important for understanding the pathogenesis of dry eyes in depth and finding new targets for the treatment and prevention of dry eyes. OBJECTIVE: To investigate the changes of the meibomian gland in a mouse model of aqueous deficient dry eyes. METHODS: Thirty-two female C57/B6 mice at 6-8 weeks were selected and randomly divided into experimental and control groups with 16 mice in each group. The mice in the experimental group were constructed by removing both the extra-orbital and intra-orbital lacrimal glands, while those in the control group were not treated. After 2 weeks of normal feeding, the corneal changes of both groups were observed under a slit lamp, and the tear secretion of both groups was measured. The meibomian glands of the two groups of mice were removed after decapitation. The changes in the gross morphology of the meibomian glands were observed and the meibomian glands were made into frozen sections. Hematoxylin-eosin staining was used to observe the structure of the meibomian glands, oil red staining was used to evaluate the function of the meibomian glands, and immunofluorescence staining and RT-qPCR were used to observe the expression of cytokeratin 14, Ki67 and abnormally differentiated small proline-rich protein 1B in the meibomian glands of mice. RESULTS AND CONCLUSION: Two weeks after modeling, lamellar defects were seen in the corneas of the experimental mice, and neovascularization of the limbal corneal was generated and invaded the central cornea. (2) Tear secretion volume was significantly reduced in the experimental group compared with the control group (P < 0.05). Microscopic findings showed that the ducts of the meibomian glands in the experimental group were interrupted and atrophied, and their arrangement was disorganized. Hematoxylin-eosin staining results showed a significant increase in lipid vacuoles in the meibomian glands of the experimental mice compared with the control group. Lipid deposition was seen in oil red staining in the experimental group. Immunofluorescence and RTqPCR results showed a significant increase in the expression of cytokeratin 14, Ki67 and small proline-rich protein 1B in the meibomian glands of mice in the experimental group compared with the control group (P < 0.05). To conclude, aqueous deficient dry eye can lead to compensatory hypertrophy, increased proliferation, and abnormal lipid metabolism in the meibomian gland, as well as abnormal differentiation of the meibomian gland. [ABSTRACT FROM AUTHOR]

Background: Diabetes, as the most common disease caused by metabolic disorders, is associated with several compli-cations, including ocular complications. The aim of this cross-sectional study was to determine the fre-quency of meibomian gland dysfunction and dry eye in patients with diabetes. Materials and Methods: In this descriptive-analytical cross-sectional study, patients with type 2 diabetes referred to the eye clinic of Farshchian Hospital (Sina) from December 2019 to October 2020 were included. Data were collected on the patients’ demographic characteristics, duration of diabetes, and HbA1c using a pre-designed checklist. The severity of dry eye was assessed by the tear breakup time (TBUT) test, while meibomian gland disorder and ocular complications were evaluated by a slit lamp. Results: In this study, 267 patients with type 2 diabetes participated. The mean age of the patients was 59.8 years, and 44.2% of them were male. Mild, moderate, and severe dry eye were observed in 34.1%, 18.0% and 5.2% of the patients, respectively. Grades 1, 2, and 3 of meibomian gland dysfunction were observed in 32.6%, 15.7%, and 5.2% of the patients respectively. Patients with poor glycemic control had higher se-verity of dry eye (p<0.001) and more meibomian gland dysfunction (p<0.001). Conclusion: Dry eye and meibomian gland dysfunction have a high prevalence in patients with diabetes mellitus, and more severe dry eye and meibomian gland dysfunction are associated with poor glycemic control and longer duration of diabetes diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate ocular surface parameters and meibomian gland dysfunction in patients who have undergone gold weight implantation for facial nerve palsy and to determine the possible relationship between eyelid weight implantation and meibomian gland dysfunction. Materials and Methods: This observational study was conducted, including 34 eyes of 17 patients with unilateral facial nerve palsy. Several parameters were compared between the affected (paralytic) eyes and the unaffected (fellow) eyes, including non-invasive tear break-up time (NI-TBUT), corneal fluorescein staining, meibomian gland dropout (MGDo), and meibography score (MS). Spearman correlation analysis was performed to determine any associations between the gold weight parameters and meibomian gland dysfunction. Results: The paralytic eyes exhibited significantly lower NI-TBUT values (p=0.001) and higher corneal fluorescein staining (p<0.001) compared to the fellow eyes. Furthermore, both the upper and lower eyelids of the paralytic side showed higher MGDo and MS values (each p-value <0.001). There were no significant differences in MGDo and MS between the lower and upper lids on both sides (each p>0.05). Moreover, no significant correlation was found between meibomian gland dysfunction and the weight of the gold implant or the duration of implantation (p>0.05). Conclusions: While meibomian gland dysfunction is commonly observed in eyes with paralytic lagophthalmos, the findings of this study suggest that eyelid weight implantation has no significant impact on meibomian gland function. [ABSTRACT FROM AUTHOR]

While the involvement of thermosensitive transient receptor potential channels (TRPs) in dry eye disease (DED) has been known for years, their expression in the meibomian gland (MG) has never been investigated. This study aims to show their expression and involvement in the lipogenesis of the MG, providing a possible new drug target in the treatment of DED. Our RT-PCR, Western blot and immunofluorescence analysis showed the expression of TRPV1, TRPV3, TRPV4 and TRPM8 in the MG at the gene and the protein level. RT-PCR also showed gene expression of TRPV2 but not TRPA1. Calcium imaging and planar patch-clamping performed on an immortalized human meibomian gland epithelial cell line (hMGECs) demonstrated increasing whole-cell currents after the application of capsaicin (TRPV1) or icilin (TRPM8). Decreasing whole-cell currents could be registered after the application of AMG9810 (TRPV1) or AMTB (TRPM8). Oil red O staining on hMGECs showed an increase in lipid expression after TRPV1 activation and a decrease after TRPM8 activation. We conclude that thermo-TRPs are expressed at the gene and the protein level in MGs. Moreover, TRPV1 and TRPM8's functional expression and their contribution to their lipid expression could be demonstrated. Therefore, TRPs are potential drug targets and their clinical relevance in the therapy of meibomian gland dysfunction requires further investigation. [ABSTRACT FROM AUTHOR]

Purpose: To report the ocular surface and meibomian gland changes in polycystic ovarian syndrome (PCOS) women taking hormone supplementation. Methods: Case series. Results: Three women (27 ± 11 years) already diagnosed with PCOS presented with dry eye symptoms (mean OSDI, 37.5) for a mean duration of 13 months and were taking hormonal supplements for a mean duration of 60 ± 11 months. The hormonal supplements included oral estrogen (n=3), oral progesterone (n=3), antiandrogen cyproterone (n=1) and isotretinoin (n=1). Ocular surface evaluation revealed mean NIBUT of 9.9 ± 1.6 seconds and mean TMH of 0.27 ± 0.05 mm, assessed non-invasively using Oculus keratograph 5M (K5M). Meibography (K5M) showed near total loss of all meibomian glands (n=8/12 eyelids) with residual ghost glands in all four eyelids of two patients, and gland shortening alone in one patient. The gland morphology did not change following intense thermal pulsation treatment or cessation of hormonal therapy. Conclusions: Near-total irreversible meibomian gland loss was seen in two young PCOS women taking hormonal supplements. Collaboration between ophthalmologists and gynecologists is advisable for early detection and better understanding of dry eye disease (DED) progression in these patients.

Abstract Background To observe morphologic and functional changes in meibomian glands in pediatric patients with and without lower eyelid epiblepharon. Methods In this prospective observation study, 55 eyes of 55 patients( 24 males, 31 females; mean age ± SD,9.82 ± 2.59 years; range 6–14 years) and 60 eyes of 60 controls ( 32 males, 28 females; mean age ± SD,10.57 ± 2.75 years; range 6–14 years) were included. The following tests were performed: eyelid margin abnormality by slit-lamp examination, measurement of noninvasive keratographic break-up time (NIKBUT), grading of absence of meibomian gland (meibography score) assessed with noncontact meibography, morphologic changes of meibomian glands (thinning, dilatation and distortion), tear production by the Schirmer 1 test, and grading of meibum quality and meibomian gland expressibility. Results The morphologic changes in meibomian glands were more common in the epiblepharon group (56.36%) than in the control group (28.33%) (p = 0.002). The meibum quality was worse in the epiblepharon group than in the control group (p = 0.009), and the NIKBUT was significantly shorter in the epiblepharon group than in the control group (p = 0.012). There was no significant difference in the Schirmer 1 test, meibomian gland expressibility, eyelid margin abnormality score or total meibography score between the two groups. Morphologic changes in the meibomian glands in the upper eyelids (38.18%) were more common than those in the lower eyelids (20%) (p = 0.036) in the epiblepharon group, and the meibography score was higher in the upper eyelids than in the lower eyelids (p = 0.001). Conclusion There are morphological and functional changes in meibomian glands in pediatric patients with lower eyelid epiblepharon. Although the inverted eyelashes were located in the lower eyelid, morphological changes in the meibomian glands were more common in the upper eyelid.

Purpose To investigate the effects of epiphora due to primary acquired nasolacrimal duct obstruction (PANDO) and external dacryocystorhinostomy (DCR) for its treatment on meibomian glands and tear film parameters. Methods External DCR for unilateral PANDO in the Department of Ophthalmology, Faculty of Medicine, Bursa Uludag University between January 2018-June 2019 were reviewed. The tear film parameters and meibography measurement recorded at the preoperative and follow-up examinations were examined on both the obstructed side and the patent side. SPSS 23 was used for statistical analyzed. Results There was a significant difference between Schirmer-1 score before external DCR (13,1±5,0; 6,3±5,0; p=0,01) and this difference disappeared after surgery (12,0±7,3; 7,7±5,0; p=0,06). Postoperative increase in non-invasive average break-up time (niAVG-BUT) on operated side was statistically significant (10,5±4,6; 12,0±5,3; p=0,033). When the healthy and operated sides were compared with each other, no significant difference was observed in niAVG-BUT before and after surgery (p=0,907, p=0,614). Mean meibomian gland losses were decreased in both operated and patent sides postoperatively and these values were statistically significant (33,0±8,2; 27,1±6,8; p

PURPOSE: We have previously used Immuno Tomography (IT) to identify label-retaining stem cell populations in the cornea and meibomian gland. While this method provides the unique ability to quantify stem cell populations comprised of 1-4 cells, the number of antigens that can be sequentially used to characterize these unique cells is limited by antigen stability after antibody stripping and re-probing. To address this deficiency, we have evaluated the capability of Imaging Mass Cytometry™ (IMC™) to generate multiplexed images using metal-conjugated antibodies to label IT plastic sections and generate 3-dimensional IMC data sets (3D IMC). METHODS: K5-H2B-GFP mice, 56 days after doxycycline chase, were sacrificed and eyelid tissue processed for IT. A total of 400 serial, plastic sections, 2 μm thick, were then probed using metal-tagged antibodies specific for sox 9, collagen type I, E-cadherin, Ki67, GFP, αSMA, vimentin, and DNA intercalator. Multiplexed images were then generated using an Imaging Mass Cytometry system (Fluidigm®), and 3D reconstructions were assembled. RESULTS: All 8 metal-labeled tags were detected and their images were successfully assembled into 3D IMC data sets. GFP-labeled nuclei were identified within the meibomian glands in comparable numbers to those previously reported for slow-cycling meibomian gland stem cells. CONCLUSIONS: These findings demonstrate that IMC can be used on plastic sections to generate multiplexed, 3D data sets that can be reconstructed to show the spatial localization of meibomian gland stem cells. We propose that 3D IMC might prove valuable in more fully characterizing stem cell populations in different tissues.

Background: To observe morphologic and functional changes in meibomian glands in pediatric patients with and without lower eyelid epiblepharon. Methods: In this prospective observation study, 55 eyes of 55 patients(24 males, 31 females; mean age ± SD,9.82 ± 2.59 years; range 6–14 years) and 60 eyes of 60 controls (32 males, 28 females; mean age ± SD,10.57 ± 2.75 years; range 6–14 years) were included. The following tests were performed: eyelid margin abnormality by slit-lamp examination, measurement of noninvasive keratographic break-up time (NIKBUT), grading of absence of meibomian gland (meibography score) assessed with noncontact meibography, morphologic changes of meibomian glands (thinning, dilatation and distortion), tear production by the Schirmer 1 test, and grading of meibum quality and meibomian gland expressibility. Results: The morphologic changes in meibomian glands were more common in the epiblepharon group (56.36%) than in the control group (28.33%) (p = 0.002). The meibum quality was worse in the epiblepharon group than in the control group (p = 0.009), and the NIKBUT was significantly shorter in the epiblepharon group than in the control group (p = 0.012). There was no significant difference in the Schirmer 1 test, meibomian gland expressibility, eyelid margin abnormality score or total meibography score between the two groups. Morphologic changes in the meibomian glands in the upper eyelids (38.18%) were more common than those in the lower eyelids (20%) (p = 0.036) in the epiblepharon group, and the meibography score was higher in the upper eyelids than in the lower eyelids (p = 0.001). Conclusion: There are morphological and functional changes in meibomian glands in pediatric patients with lower eyelid epiblepharon. Although the inverted eyelashes were located in the lower eyelid, morphological changes in the meibomian glands were more common in the upper eyelid. [ABSTRACT FROM AUTHOR]

A 71-year-old female with invasive squamous cell carcinoma of the lower eyelid involving the ocular surface underwent surgical excision with negative margins and a subsequent reconstruction. The posterior lamellar defect was reconstructed with a Hughes tarsoconjunctival flap, and the anterior lamellar defect was reconstructed by advancing the lower eyelid skin. Three years later, the patient presented with signs suspicious for recurrence involving the tarsoconjunctival graft: a nodule along the mucocutaneus junction, symblepharon, and forniceal shortening. Repeat scouting biopsies showed variable degrees of moderate to severe squamous dysplasia so the patient underwent a staged full thickness excision of the lower eyelid and involved conjunctiva followed by reconstruction. Direct immunofluorescence was not diagnostic for ocular cicatrcial pemphigoid. Permanent histopathologic sections did not show any carcinoma, but the full thickness excisions involving the prior Hughes tarsoconjunctival flap highlighted two notable alterations: the Meibomian glands were absent and the accessory lacrimal glands of Wolfring were transposed to the mucocutaneous junction of the reconstructed lower eyelid. [ABSTRACT FROM AUTHOR]

Purpose: To explore the long-term course of patients with meibomian gland dysfunction (MGD), and to analyse potential factors affecting the recovery of meibomian gland (MG) dropout. Methods: Seventy-nine MGD patients (79 eyes) aged 36.03±15.78 years old who underwent more than one year of follow-up were enrolled in this retrospective study. Corneal fluorescein staining (CFS), tear meniscus height (TMH), noninvasive breakup time (NIBUT), and noncontact meibography at baseline and last visit were collected and analysed. Then an automatic MG analyzer was used to measure the morphological and functional parameters of MGs, including their area ratio (AR), tortuosity index (TI), and signal index (SI). The patients whose AR increased by more than 5% were defined as MG improvement, and AR decreased by more than 5% was MG worsening. Results: A total of 79 patients (79 eyes) were assessed with at least 1-year of follow-up. More than 1/3 of MGD patients (27 eyes, 34.2%) underwent MG improvement, and 30.4% of MGs became worsened. Age (P=0.002), gender (P<0.001), IPL treatment (P=0.013), the change of CFS (P=0.0015), and the recovery of SI (P=0.035) showed significant differences among different recovery groups. Age(P<0.001), female sex (P=0.003), ΔCFS (P<0.001), AR at baseline (P<0.001) were negative correlation with AR recovery, and the change of SI (P=0.003) and IPL treatment (P=0.003) had a positive correlation with it. Among them, age (P=0.038), the change of CFS (P=0.004), and AR at baseline (P=0.007) were confirmed as negatively correlated factors predicting the long-term change of the MG. Conclusion: Although the MGD treatment has continued for more than 1 year, only 34.2% of MGD patients were observed to undergo MG improvement. Younger patients and patients with better CFS recovery seem to have more opportunities to improve their MGs. [ABSTRACT FROM AUTHOR]

• A hyaluronan (HA) matrix exists surrounding the basal layer of the Meibomian gland (MG) and in the tarsal plate that is essential for maintaining MG homeostasis. • The HA matrix suffers age related changes that are associated with MG atrophy and dropout. • An increase in HA expression can prevent ARMGD, while a loss in HA expression causes MGD. • Novel therapeutic interventions geared towards preventing a loss of the HA matrix in the MG and tarsal plate could prevent ARMGD. The prevalence of dry eye disease (DED) ranges from ∼5 to 50 % and its associated symptoms decrease productivity and reduce the quality of life. Approximately 85 % of all DED cases are caused by Meibomian gland dysfunction (MGD). As humans and mice age, their Meibomian glands (MGs) undergo age-related changes resulting in age related-MGD (ARMGD). The precise cause of ARMGD remains elusive, which makes developing therapies extremely challenging. We previously demonstrated that a hyaluronan (HA)-rich matrix exists surrounding the MG, regulating MG morphogenesis and homeostasis. Herein, we investigated whether changes to the HA matrix in the MG throughout life contributes towards ARMGD, and whether altering this HA matrix can prevent ARMGD. For such, HA synthase (Has) knockout mice were aged and compared to age matched wild type (wt) mice. MG morphology, lipid production, PPARγ expression, basal cell proliferation, stem cells, presence of atrophic glands and MG dropout were analyzed at 8 weeks, 6 months, 1 year and 2 years of age and correlated with the composition of the HA matrix. We found that as mice age, there is a loss of HA expression in and surrounding the MGs of wt mice, while, in contrast, Has1−/−Has3−/− mice present a significant increase in HA expression through Has2 upregulation. At 1 year, Has1−/−Has3−/− mice present significantly enlarged MGs, compared to age-matched wt mice and compared to all adult mice. Thus, Has1−/−Has3−/− mice continue to develop new glandular tissue as they age, instead of suffering MG atrophy. At 2 years, Has1−/−Has3−/− mice continue to present significantly larger MGs compared to age-matched wt mice. Has1−/−Has3−/− mice present increased lipid production, increased PPARγ expression and an increase in the number of proliferating cells when compared to wt mice at all-time points analyzed. Taken together, our data shows that a loss of the HA matrix surrounding the MG as mice age contributes towards ARMGD, and increasing Has2 expression, and consequently HA levels, prevents ARMGD in mice. [ABSTRACT FROM AUTHOR]

Background: Meibomian gland dysfunction (MGD) is one of the most encountered diseases in the clinical practice but appears to be underappreciated as it does not cause blindness. Meibomian gland dysfunction is a multifactorial and complex disorder of the ocular surface. Aim: This study aims to evaluate the characteristics of the meibomian glands in individuals living with HIV and AIDS undergoing antiretroviral therapy. Setting: The study was conducted at the antiretroviral (ARV) clinic, Mankweng Hospital. Methods: This was a prospective study conducted with 37 HIV and AIDS participants and 20 healthy controls. All participants were assessed using the Ocular Surface Diseases Index (OSDI) score and, tear break-up time and lid margin regularity (using the slit-lamp biomicroscopy). The loss of the meibomian glands was evaluated using the Marx’s line. For this study, this line represented a clinical parameter of meibomian function. Results: The OSDI score was significantly higher in the HIV and AIDS group than that of the control participants (39.95 ± 18.65 and 13.00 ± 9.09, respectively, P 0.05). The tear breakup time (TBUT) for the HIV and AIDS study group was lower than that of the control group (7.95 ± 3.54 and 9.90 ± 3.70, respectively, P 0.05). The HIV and AIDS participants showed greater meibomian gland loss relative to the healthy controls (9.30 ± 4.97 and 5.70 ± 2.1, P 0.05). Conclusion: The loss of eyelid meibomian glands is common in people living with HIV and AIDS in comparison with healthy controls. Contribution: Although there is a decrease in sight-threatening complications in the era of ARVs, ocular surface disorders (OSD) are still commonly found, which may reduce the quality of life of HIV and AIDS individuals.

AIM: To investigate the effects of primary acquired nasolacrimal duct obstruction(PANDO)on the tear film and ocular surface using LipiView ocular surface interferometer and Keratograph 5M anterior segment analyzer.METHODS: A self-controlled clinical trials. A total of 40 patients diagnosed with unilateral PANDO for at least 6mo who were admitted to our department from September 2021 to March 2022 were enrolled in the study, and the healthy eyes of the patients were assessed as control group. The LipiView ocular surface interferometer and Keratograph 5M anterior segment analyzer were used to measure the changes in related parameters of the tear film and ocular surface in both eyes.RESULTS: The non-invasive tear meniscus height(NITMH), stimulated NITMH, loss rate of upper meibomian gland, nasal and temporal ciliary redness index, temporal conjunctival redness index of the affected eyes were higher than healthy eyes(P0.05).CONCLUSION: PANDO may lead to the aggravation of ocular surface inflammation and the loss of upper meibomian gland, and damage the ocular surface of patients. Attention should be paid to the early treatment of PANDO.

PURPOSE: Previously, we showed that Acyl-CoA wax-alcohol acyltransferase 2 (AWAT2), an essential enzyme required for meibum wax ester synthesis, was not expressed by immortalized human meibomian gland epithelial cells (hMGEC) in culture. To begin to understand the mechanisms controlling AWAT2 expression, we have analyzed its expression in human and rabbit meibomian glands and cultured meibocytes. METHODS: Rabbit meibocyte progenitor cells (rMPC) were first grown in Cnt-BM.1 basal medium (Cellntec) supplemented with rhEGF, FGF10, and ROCK inhibitor (Y-27632 dihydrochloride), and then passed at 70-80% confluency with Accutase. Differentiation of rMPC to meibocytes (rMC) was induced by removal of Y-27632 and addition of 1 mM calcium with and without PPARγ agonists. RNA from the tissue, primary, passaged rMPC and differentiated rMC were obtained for AWAT2 qPCR analysis. Proteins and cells were evaluated for western blotting and neutral lipid synthesis, respectively. For comparison, human meibomian glands were separated for RNA and protein analysis. hMGEC was cultured to collect RNA and protein. RESULTS: Rabbit rMPCs were successfully grown, passaged, and differentiated, showing a significant increase in lipid droplet accumulation. AWAT2 RNA was highly expressed in tissue but showed a -16.9 log2 fold decrease in primary and passaged rMPCs and was not induced by differentiation to rMC. By comparison, human meibomian glands showed high expression of AWAT2, and hMGEC expressed non-detectable levels of AWAT2 transcripts or protein. CONCLUSIONS: AWAT2 expression is lost in cultured rMPC and rMC suggesting that cells in culture do not undergo complete meibocyte differentiation and require yet to be identified culture conditions.

Microbiota present around the ocular surface, encompassing the eyelid skin, the conjunctival sac, and the meibomian glands, play a significant role in various inflammatory conditions associated with the ocular surface. Cutibacterium acnes (C. acnes), formerly, Propionibacterium acnes, is one of the most predominant commensal bacteria and its relative abundance declines with aging. However, it can act as both an infectious and an immunogenic pathogen. As an infectious pathogen, C. acnes has been reported to cause late onset endophthalmitis post-cataract surgery and infectious keratitis. On the other hand, it can trigger immune responses resulting in conditions such as phlyctenules in the cornea, chalazion in the meibomian glands, and granuloma formation in ocular sarcoidosis. This review explores the role of C. acnes in ocular inflammation, specifically highlighting its implications for diagnosis and management.

The aim of the study was to investigate the expression levels of ACE2 in ocular glands and to investigate the effect of S protein on them. Male C57BL/6J mice were used for the experiments. The expression levels of ACE2 are highest in the Meibomian glands, followed by the conjunctiva, the cornea, and the lacrimal glands. Co-immunoprecipitation assays confirmed direct binding between ACE2 and S protein in ocular surface epithelia and Meibomian glands. CD45+ cell infiltration was found in the S protein treatment group, which was accompanied by upregulation of inflammation-related cytokines. There was also prominent cell apoptosis in the S protein treatment group. In conclusion, not only the cornea and the conjunctiva, but also the Meibomian glands express ACE2, and S protein could induce ocular surface epithelial cell and Meibomian gland cell inflammation and apoptosis.

Abstract Introduction The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. Methods Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer’s test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. Results In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p

Meibomian gland dysfunction (MGD) is a group of disorders linked by functional abnormalities of the meibomian glands. Current studies on MGD pathogenesis focus on meibomian gland cells, providing information on a single cell's response to experimental manipulation, and do not maintain the architecture of an intact meibomian gland acinus and the acinar epithelial cells' secretion state in vivo. In this study, rat meibomian gland explants were cultured by a Transwell chamber-assisted method under an air-liquid interface (airlift) in vitro for 96 h. Analyses for tissue viability, histology, biomarker expression, and lipid accumulation were performed with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and TUNEL assays, hematoxylin and eosin (H&E) staining, immunofluorescence, Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR), transmission electron microscopy (TEM), and western blotting (WB). MTT, TUNEL, and H&E staining indicated better tissue viability and morphology than the submerged conditions used in previous studies. Levels of MGD biomarkers, including keratin 1 (KRT1) and 14 (KRT14) and peroxisome proliferator-activated receptor-gamma (PPAR-γ), along with oxidative stress markers, including reactive oxygen species, malondialdehyde, and 4-hydroxy-2-nonenal, gradually increased over culture time. The MGD pathophysiological changes and biomarker expression of meibomian gland explants cultured under airlift conditions were similar to those reported by previous studies, indicating that abnormal acinar cell differentiation and glandular epithelial cell hyperkeratosis may contribute to obstructive MGD occurrence. [ABSTRACT FROM AUTHOR]

Objective: To describe a case of lipogranulomatous conjunctivitis in a horse. Animal Studied: A client‐owned 12‐year‐old Standardbred gelding presenting with chronic conjunctivitis and palpebral masses. Methods: Complete ophthalmic examination, surgical excision, histopathology, and bacterial culture of biopsy samples were performed. Results: Upper and lower eyelids of both eyes were affected, with multiple yellow‐to‐white nodules on the palpebral conjunctiva, adjacent to the eyelid margin. Nodule removal was achieved via partial tarsal plate excision. Histopathological examination revealed granulomatous inflammation and large droplets of presumed free lipid in the conjunctival lamina propria. The animal was diagnosed with lipogranulomatous conjunctivitis. No postoperative ocular discomfort was observed for months; however, 3 years later, new conjunctival nodules were noticed, requiring a second surgical procedure on three of the eyelids. Transient entropion in the left lower eyelid was observed 2 months after the second surgery, and no recurrence of conjunctival nodules was observed after 18 months of follow‐up. Conclusion: To our knowledge, this is the first report of lipogranulomatous conjunctivitis in horses. [ABSTRACT FROM AUTHOR]

The main function of exocrine Meibomian glands (MGs) is to produce a lipid-rich secretion called meibum which plays a critical role in maintaining the ocular surface homeostasis of humans and most mammals. The chemical composition of meibum, and its quantity produced by MGs, largely determine whether it can fulfill its role successfully. Aging was frequently associated with the onset of various MG-related pathologies. The goal of this study was to determine how aging affects the chemical composition and quantity of meibum in mice, and identify possible molecular markers of aging. Unbiased, untargeted and targeted lipidomic evaluation of mouse MG lipids was conducted using liquid chromatography—high-resolution mass spectrometry, and the results were analyzed using Principal Component, Orthogonal Projections to Latent Structures Discriminant, and Partial Least Square Discriminant Analyses. We found that aging leads to dysregulation of lipid metabolism in MGs, changing the ratios of major classes of MG lipids (such as wax esters, triacylglycerols, and phospholipids) in a progressive manner. Several lipid species that belong to these groups of MG lipids are proposed as clear markers of aging in a mouse model. [ABSTRACT FROM AUTHOR]

Abstract Background Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8–15 years. Methods This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups. Results At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 μm and 18.65 ± 0.04 μm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests. Conclusions The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.

Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms. In recent years, the incidence of dry eye has been increasing year by year, and the diagnosis and treatment of dry eye are constantly evolving and innovating. However, due to the corresponding drawbacks of traditional examination methods and the lack of a large number of clinical trial studies on new examination methods, there is still no unified standard for the diagnosis and treatment of dry eye. In this review, we have performed a broad search for articles discussing different examination methods for dry eye, including promising diagnostic tools and technique, the latest advances, and contradictions, in order to provide a review of dry eye examination methods including the tear volume, the tear film, the eyelid and meibomian gland, and the degree of damage to the epithelial cells of the ocular surface, and provide a reference for the diagnosis and treatment of dry eye.

Purpose: To report the ocular surface and meibomian gland changes in polycystic ovarian syndrome (PCOS) women taking hormone supplementation. Methods: Case series. Results: Three women (27 ± 11 years) already diagnosed with PCOS presented with dry eye symptoms (mean OSDI, 37.5) for a mean duration of 13 months and were taking hormonal supplements for a mean duration of 60 ± 11 months. The hormonal supplements included oral estrogen (n=3), oral progesterone (n=3), antiandrogen cyproterone (n=1) and isotretinoin (n=1). Ocular surface evaluation revealed mean NIBUT of 9.9 ± 1.6 seconds and mean TMH of 0.27 ± 0.05 mm, assessed non-invasively using Oculus keratograph 5M (K5M). Meibography (K5M) showed near total loss of all meibomian glands (n=8/12 eyelids) with residual ghost glands in all four eyelids of two patients, and gland shortening alone in one patient. The gland morphology did not change following intense thermal pulsation treatment or cessation of hormonal therapy. Conclusions: Near-total irreversible meibomian gland loss was seen in two young PCOS women taking hormonal supplements. Collaboration between ophthalmologists and gynecologists is advisable for early detection and better understanding of dry eye disease (DED) progression in these patients.

PURPOSE: While mouse models of dry eye disease (DED) have been developed, studies evaluating the role of the meibomian glands limited by the inability to temporally document changes. In this report we describe the development of a novel mouse transillumination meibography device and assess the ability of this device to detect age-related changes in the meibomian glands of young and old mice. METHODS: The mouse meibography device was comprised of a 3 mm wide right angle prism attached to broad spectrum light source by an optical fiber. Eyelids were then pulled over the prism using double tooth forceps and imaged using a stereomicroscope and low light level camera. Meibomian glands from four young and four old male, BALB/c mice were then imaged and analyzed using ImageJ. RESULTS: In young mice, meibography documented the presence of 7-8 meibomian glands appearing as black and distinct eyelid structures with the length shorter in the lower eyelid compared to the upper eyelids. Eyelids of old mice showed apparent dropout of meibomian glands along with smaller and more irregularly shaped acini. The mean acini area of one meibomian gland was 0.088 ± 0.025 mm2 in young mice and 0.080 ± 0.020 mm2 in old mice (p = 0.564), but the Meibomian gland density was significantly lower in older mice (41.7 ± 6.4%, 27.3 ± 4.2%) (p = 0.021). CONCLUSION: We have developed an in vivo meibography device that may prove useful in sequentially documenting changes during development of meibomian gland dysfunction and following treatment.

BackgroundDistichiasis, an ocular disorder in which aberrant cilia (eyelashes) grow from the opening of the Meibomian glands of the eyelid, has been reported in Friesian horses. These misplaced cilia can cause discomfort, chronic keratitis, and corneal ulceration, potentially impacting vision due to corneal fibrosis, or, if secondary infection occurs, may lead to loss of the eye. Friesian horses represent the vast majority of reported cases of equine distichiasis, and as the breed is known to be affected with inherited monogenic disorders, this condition was hypothesized to be a simply inherited Mendelian trait.ResultsA genome wide association study (GWAS) was performed using the Axiom 670 k Equine Genotyping array (MNEc670k) utilizing 14 cases and 38 controls phenotyped for distichiasis. An additive single locus mixed linear model (EMMAX) approach identified a 1.83 Mb locus on ECA5 and a 1.34 Mb locus on ECA13 that reached genome-wide significance (pcorrected = 0.016 and 0.032, respectively). Only the locus on ECA13 withstood replication testing (p = 1.6 × 10- 5, cases: n = 5 and controls: n = 37). A 371 kb run of homozygosity (ROH) on ECA13 was found in 13 of the 14 cases, providing evidence for a recessive mode of inheritance. Haplotype analysis (hapQTL) narrowed the region of association on ECA13 to 163 kb. Whole-genome sequencing data from 3 cases and 2 controls identified a 16 kb deletion within the ECA13 associated haplotype (ECA13:g.178714_195130del). Functional annotation data supports a tissue-specific regulatory role of this locus. This deletion was associated with distichiasis, as 18 of the 19 cases were homozygous (p = 4.8 × 10- 13). Genotyping the deletion in 955 horses from 54 different breeds identified the deletion in only 11 non-Friesians, all of which were carriers, suggesting that this could be causal for this Friesian disorder.ConclusionsThis study identified a 16 kb deletion on ECA13 in an intergenic region that was associated with distichiasis in Friesian horses. Further functional analysis in relevant tissues from cases and controls will help to clarify the precise role of this deletion in normal and abnormal eyelash development and investigate the hypothesis of incomplete penetrance.

Purpose: To report the ocular surface and meibomian gland changes in polycystic ovarian syndrome (PCOS) women taking hormone supplementation. Methods: Case series. Results: Three women (27 ± 11 years) already diagnosed with PCOS presented with dry eye symptoms (mean OSDI, 37.5) for a mean duration of 13 months and were taking hormonal supplements for a mean duration of 60 ± 11 months. The hormonal supplements included oral estrogen (n=3), oral progesterone (n=3), antiandrogen cyproterone (n=1) and isotretinoin (n=1). Ocular surface evaluation revealed mean NIBUT of 9.9 ± 1.6 seconds and mean TMH of 0.27 ± 0.05 mm assessed non-invasively using Oculus keratograph 5M (K5M). Meibography (K5M) showed near total loss of all meibomian glands (n=8/12 eyelids) with residual ghost glands in all four eyelids of two patients, and gland shortening alone in one eyelid. The gland morphology did not change following intense thermal pulsation treatment or cessation of hormonal therapy. Conclusions: Near-total irreversible meibomian gland loss was seen in two young PCOS women taking hormonal supplements. Collaboration between ophthalmologists and gynecologists is advisable for early detection and better understanding of dry eye disease (DED) progression in these patients.

Introduction: The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands. Methods: Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed. Results: In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = − 0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates. Conclusion: Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage. [ABSTRACT FROM AUTHOR]

• Chalazia are localized cysts of chronic lipogranulomatous inflammation. • The authors trace the chalazion's history from Ancient Babylon to the modern era. • Neoplasms must be considered for recurrent chalazia with atypical features. • This article summaries our current understanding of the chalazion. Chalazia are localized cysts of chronic lipogranulomatous inflammation arising from the obstruction of sebaceous glands of the eyelid tarsal plate, including the Meibomian gland (deep chalazion) or Zeis gland (superficial chalazion). This disease entity is differentiated from the hordeolum (stye), an acute purulent localized swelling of the eyelid often associated with an eyelash follicle, Zeis gland, or Moll gland obstruction and infection. Ambiguously, the chalazion, hordeolum, and blepharitis are commonly categorized and described on a continuum in the literature. While it is one of the most common eyelid disorders across all age demographics, the chalazion remains largely understudied and pathophysiological, epidemiological, and therapeutic findings exist fragmented in the literature. We discuss current understandings of the chalazion and provide current best practice guidelines supported by clinical anecdotal evidence. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Chinese herbal medicine hot pack therapy combined with meibomian gland massage on relieving uncomfortable symptoms of patients with dry eye of liver-kidney Yin deficiency. Methods Totally 100 patients with dry eye of Liver-kidney Yin deficiency were randomly divided into the study group and control group, with 50 cases in each group. All patients received routine treatment and nursing, and those in the study group were given three course of Chinese herbal medicine hot pack therapy combined with meibomian gland massage. Results The overall effective rate in the study group was higher than that in the control group (98. 00% vs. 70. 00%, P

Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.

BACKGROUND: Pterygium is a commonly occurring ocular pathology, characterized by a benign proliferation of conjunctiva which extends onto the corneal surface. Abnormal tear film and meibomian gland (MG) dysfunction have been linked to pterygium development. AIMS: This study was done to evaluate the changes taking place in the Ocular Surface Disease Index (OSDI) score and other tear film parameters with MG parameters in patients of primary pterygium as well as evaluation of the relation between them in pterygium. SETTINGS AND DESIGN: This was a case–control study, done in a tertiary care hospital in North India. MATERIALS AND METHODS: Patients presenting to the ophthalmology outpatient department with a diagnosis of pterygium were enrolled in the pterygium study group along with their gender- and age-matched controls. Both groups were evaluated for OSDI score and other tear films and MG parameters were compared. STATISTICAL ANALYSIS USED: The results were analyzed using SPSS version 24.0. A P < 0.05 was considered statistically significant. RESULTS: The OSDI score was significant among the study groups with a P = 0.006 and the MG parameters of MG expression score, lid margin abnormality, and meiboscore were also significant with a P = 0.002, 0.002, and < 0.01, respectively. CONCLUSIONS: There is a positive association between pterygium, tear film abnormality, and MG disease (MGD). A strong association was also established between MGD and dry eye. Any alteration in one will aggravate the other.