Meibomian Gland Dysfunction Signs and Symptoms Demonstrate Poor Correlation

Careful clinical consideration must be given to patients who present with signs of meibomian gland dysfunction and no symptoms, and vice versa.

Little correlation exists between symptoms and signs in patients with meibomian gland dysfunction (MGD), according to a study published in BMC Ophthalmology. Age, hormones and dry environments may influence the disease, according to the report. 

Researchers enrolled 122 patients with MGD (95 women; mean age, 42.2 years) who were recruited for intense pulsed light therapy (IPL) and divided them into different subgroups based on possible influencing factors. The team assessed MGD symptoms using the standard patient evaluation of eye dryness (SPEED) questionnaire. 

Patients underwent clinical examinations which included evaluations of tear breakup time (TBUT), meibomian gland yielding secretion score (MGYSS) and corneal fluorescein staining score (CFSS). Meibum expression was evaluated in 3 positions (nasal, medial, temporal) of the lower lid.

Clinically, there is a group of patients whose meibomian glands are obstructed and secrete viscous or even toothpaste-like secretions under pressure, but they have no symptoms or have mild symptoms; there is a group of patients with obvious symptoms of MGD and often seek medical attention, but no abnormalities are detected during the clinical examination.

The report shows that SPEED score was not correlated with TBUT (r=0.017, P =.852), CFSS (r=-0.171; P =.060), MGYSS (r=-0.144; P =.112) or any index of eyelid margin abnormality (P >.05). 

Lid margins abnormalities, hyperemia, lid thickening, rounding, hyper keratinization, and telangiectasia were more likely to occur in patients who were older than 40 years, menopausal, or living in northern China. 

Linear regression analysis indicated no correlation between MGD symptoms and signs (P >.05) after adjusting for influencing factors. Menopause was associated with SPEED score (R=-4.112, P =.025), while age and geographic region were associated with eyelid margin abnormalities.

The report suggests that presenting with MGD symptoms without signs, and vice versa, should warrant careful clinical evaluation. “Clinically, there is a group of patients whose meibomian glands are obstructed and secrete viscous or even toothpaste-like secretions under pressure, but they have no symptoms or have mild symptoms; there is a group of patients with obvious symptoms of MGD and often seek medical attention, but no abnormalities are detected during the clinical examination,” according to the researchers.

Study limitations include the exclusion of patients who had recent eye or eyelid surgery and a small sample size.

This article originally appeared on Optometry Advisor

References:

Xie L, Chen S, Hong J, et al. The lack of correlation between symptoms and signs in patients with meibomian gland dysfunction: a secondary analysis of the multicenter, randomized controlled trial. BMC Ophthalmol. Published online August 28, 2022. doi:10.1186/s12886-022-02576-8