Study: Evaluate Meibomian Gland Anatomy Before Refractive Surgery

close up of the conjunctival papilly during eye examination.
Researchers show the application of preoperative meibography.

Meibography can aid clinicians in identifying meibomian gland atrophy, according to a study in Clinical Ophthalmology. A diagnosis of meibomian gland atrophy may help guide refractive surgery decisions.

Meibomian gland atrophy is the assumed result of chronic meibomian gland dysfunction (MGD) due to increased oil viscosity or hyperkeratinization, stasis, increased pressure with gland dilation, and subsequent gland acini atrophy, the study explains. 

The cross-sectional study examined the left eyes, selected at random for analysis, of a total of 120 patients between the ages of 21 and 62 who had presented to the Duke Eye Center from December 2018 through January 2020. Patient medical records were reviewed to collect relevant medical information and history including contact lens use, artificial tear use, prior ocular surgery, and biomicroscopic slit lamp evaluation. All patients also underwent meibography of the inferior eyelids. Images were graded by an experienced grader for gland atrophy (on a 4-point scale) and gland tortuosity (on a 3-point scale). Lipid layer thickness (LLT) and partial blink data were also obtained. Patients were divided for analysis by age with the younger group being under 35 years and the older group being 35 and up for analysis.

Results revealed that of the examined patients 72.5% had some evidence of MGD with most patients having mild gland atrophy and 8.5% of atrophy. Likewise, 69.2% of patients had some evidence of meibomian gland tortuosity and 21.7% showed high tortuosity.  The mean meiboscale value was approximately 0.89for the patients younger than 35 and 1.38 for those older than 35 (P =.0). The mean LLT was approximately 68.1 nm and the mean proportion of partial blink was 53%. No significant correlation was observed between contact lens wear or gender and a moderate positive relationship was seen between meiboscale and tortuosity.

“A higher prevalence of atrophy with age may make the assessment of meibomian glands of potentially greater importance when considering refractive surgery,” the report shows. 

The research was limited in that the investigators assessed the meibomian glands only once. Additionally, the study population was sampled from a single tertiary care center, which could create selection bias. Finally, the study did not correlate patient symptoms with their meibomian gland anatomy.

Disclosure: A study author declared affiliations with the biotech and pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.


Brooks CC, Gupta PK. Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery EvaluationClin Ophthalmology. 2021;15:315-321. doi:10.2147/OPTH.S292919.