Irregular Lid Margins Are Linked to Meibomian Gland Dropout

Reddened eye with suppuration on eyelashes closeup.
Researchers evaluated patients with different lid types using meibography.

Patients with irregular lid margins are more likely to experience meibomian gland dropout (MGD), according to findings published in The Ocular Surface.

MGD is traditionally diagnosed by identifying lid margin abnormalities or changes in meibum secretion. In this study, investigators looked at the relationship between lid margin abnormalities and meibomian gland loss using infrared meibography. While it was predicted that abnormal eyelid margins indicate more meibomian gland loss (dropout) in meibography, there were no published reports confirming that this was true. 

To further understand this relationship, researchers conducted a retrospective chart review of 170 patients (173 eyes) who were diagnosed with dry eye disease. To be included in the study, patients had to be at least 20 years old with at least mild dry eye symptoms (Ocular Surface Disease Index [OSDI] score ≥13) and low tear film break-up time (TBUT<5 s) using fluorescein eye, or low Schirmer I score (<10 mm per 5 min without anesthesia), or corneal punctate fluorescein staining (Oxford staining score of >1) in at least 1 eye. Exclusion criteria included a history of ocular injury, infection, non-dry-eye ocular inflammation, trauma, surgery within the previous 6 months, and uncontrolled systemic diseases.

The analysis included 141 eyes of 37 males and 104 females with a mean age of approximately 55 years. Each participant was evaluated with a patient history questionnaire, air tonometry, and best-corrected visual acuity. Then, an ophthalmic examination with slit-lamp microscopy was performed to investigate lid margins and meibomian gland orifices. The investigating team graded a variety of lid margin abnormalities, including irregular lid margin, vascular engorgement, plugging, anterior placement of the mucocutaneous junction, exposed terminal duct, and the presence of tattoos. Multiple regression analyses were performed with meiboscore (meibomian gland dropout grade) as the dependent variable and age, sex, lid margin abnormality grades, and total grading score of lid margin abnormalities as the covariates. Meibomian glands structure was examined in those with eyelid margin dimpling using meibography in 25 eyes.

The team found that, in the upper eyelids, the meiboscores of patients with higher grades of irregular lid margins was higher than the meiboscores of those without irregular lid margins (P =.065, Fisher’s exact test). The associations between the meiboscores and other lid margin abnormalities were not significant. In the lower eyelids, the meiboscores of patients with higher grades of irregular lid margins and orifice plugging were higher than those of patients without these features (P =.002, P =.037, Fisher’s exact test). The associations between the meiboscores and other lid margin abnormalities were not significant. 

In the multiple regression analysis, an irregular lid margin in the upper lid was associated with a higher meiboscore after controlling for age and sex (coefficients B=1.379, P =.025). In the lower eyelids, irregular lid margin (coefficients B=0.602, P =.009) and total grading score of lid margin abnormality were associated with higher meiboscores (coefficients B=0.100, P =.022). Of the 25 eyes with dimples, 21 (84%) showed focal or complete meibomian gland loss at the site.

“This is the first report to directly observe meibomian gland loss at the site of margin dimpling using an infrared video camera,” investigators explain. “We think that as a meibomian gland becomes atrophic, a lid margin dimple appears due to tissue absorption in the region of the orifice, and if there is more than one dimple, irregular lid margins are observed.”


Ha M, Kim JS, Hong S-Y, et al. Relationship between eyelid margin irregularity and meibomian gland dropout. Ocul Surf. 2021:19(1):31-37. doi:10.1016/j.jtos.2020.11.007.