Patients With Polycystic Ovarian Syndrome May Have Greater Meibomian Gland Loss

The human eye
The human eye
The study suggests the endocrine system plays a significant role in the regulation of the ocular surface and adnexa.

Meibomian gland loss is associated with polycystic ovarian syndrome (PCOS), researchers report in a study published in Photodiagnosis and Photodynamic Therapy.

PCOS, a common endocrine disease impacting women of reproductive age, is a risk factor for insulin resistance and hyperandrogenism. Dysfunction of sex hormones can affect the meibomian gland and impact dry eye symptoms. Limited research has investigated corneal and anterior chamber characteristics of patients with PCOS.

The objective of the current study was to make the first noninvasive, objective comparison of the features of meibomian glands, tear film break-up time (TBUT) and corneal and anterior segment measurements between patients with PCOS and healthy control individuals.

Researchers conducted the study at a hospital in Turkey. They prospectively evaluated 66 patients with PCOS and 42 healthy control individuals between 18 to 35 years old, between September 2018 and January 2019. Ocular exams were conducted in the follicular phase of the menstrual cycle. Patients included in the study had not received hormonal treatment for infertility or used oral contraceptive drugs in the past 6 months.

The investigators performed segment analyses, corneal topography, meibography and TBUT with the noncontact, noninvasive Scheimpflug camera system.

They found that mean meibomian gland loss was greater in the PCOS group (29.9±11.9) compared with the control group (20.8±11.0 P <.001). Sixty-four eyes in the PCOS group (96.9%) and 36 eyes in the control group (85.7%) experienced meibomian gland loss. 

Mean NITBUT and body mass index (BMI) were inversely correlated in the control group. The investigators found associations between 17-Hydroxy (OH) Progesterone (prog) and mean NITBUT and OSDI scores and between dehydroepiandrosterone-sulfate (DHEA-S) and MG loss. They did not find correlations between estradiol, total testosterone, 17-OH prog, DHEA-S, BMI, and tear function tests in the PCOS group.

The investigators did not find significant differences between the groups in hormonal and metabolic measures, central and thinnest corneal thickness, horizontal visible iris diameter (HVID), anterior chamber depth (ACD), anterior chamber volume (ACV), irido-corneal angle (ICA), corneal volume (CV), or mean keratometry (Km) values.

“The results of this study showed that MG loss is a physiological process that is distinct in PCOS patients but does not cause tear film alterations,” the investigators report. “In these patients, factors that caused MGD could be subclinical inflammation as well as hyperandrogenism and insulin resistance. Further studies are needed to show the factors contributing to MGD in PCOS patients. MGD in PCOS may be overlooked in clinical practice and PCOS patients should be routinely examined by eyecare practitioners.”

Limitations of the study include lack of evaluation of the lower eyelids and daily life activities, such as screen time.


Yücekul B, Gürlek B. Non-invasive evaluation of meibomian gland morphology and tear film and anterior segment parameters in women with polycystic ovarian syndrome. Photodiagnosis and Photodynamic Therapy. Published online November 26, 2021. doi:10.1016/j.pdpdt.2021.102654