Objective: To investigate the effects of ocular prosthesis on meibomian glands and also to identify the role of meibomian gland dysfunction (MGD) on ocular discomfort in prosthetic eyes. Methods: This prospective study included 55 patients who had been wearing unilateral ocular prosthesis for more than 1 year. A 15-item questionnaire regarding MGD-related ocular symptoms was administered to all patients. Both prosthetic eyes and paired normal eyes were evaluated with slit-lamp, noncontact meibography and spectral optical coherence tomography. A multiple linear regression model was applied to evaluate factors on ocular symptom scores. Results: The ocular symptom scores, meibography scores, meibomian gland loss, and lid margin abnormality scores of prosthetic eyes were significantly higher than those of normal eyes (P<0.05). Tear meniscus measurements of eyes with prosthesis were significantly lower from those of normal eyes (P<0.05). The ocular symptom scores were significantly positively correlated with meibography scores, meibomin gland loss, and lid margin abnormality scores and negatively correlated with tear meniscus measurements (P<0.05). There was a significant negative correlation between total meibography scores and all tear meniscus parameters (P<0.05). The patients who had used ocular prosthesis for longer durations had a significantly greater meibography scores, meibomin gland loss, lid margin abnormality scores, and ocular symptom scores but lesser tear meniscus parameters (P<0.05). Conclusion: Use of ocular prosthesis is significantly associated with MGD, which is proportional to the duration of prosthesis wear. Furthermore, ocular discomfort symptoms of prosthetic eye wearers significantly correlated with MGD-related dry eye.

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To investigate whether meibomian gland dysfunction is the cause of dry eye in facial nerve palsy and to identify the possible relationship between the grades and durations of facial nerve palsy and meibomian gland dysfunction. Methods: This prospective observational study included 63 patients with unilateral facial nerve palsy. Facial nerve function and severity were assessed using the House-Brackmann grading system. Unaffected contralateral eyes were used as the control group. The following parameters were compared: tear breakup time, Schirmer 1 test score, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores, and areas of meibomian gland loss. A Pearson correlation analysis was performed between the grades and durations of facial nerve palsy and meibomian gland dysfunction. Results: The eyes affected by facial nerve palsy demonstrated significantly lower tear breakup time (p<0.001) and significantly higher values for corneal fluorescein staining (p<0.001), Schirmer 1 test score (p=0.042), lid abnormality score (p<0.05), meibomian gland expression level (p=0.005), meibography scores (p<0.05), and areas of meibomian gland loss (p<0.05). The grade and duration of facial nerve palsy significantly correlated with meibomian gland dysfunction (p<0.05). Conclusions: Meibomian gland dysfunction has a significant contribution to the development of dry eye disease after facial nerve palsy. Furthermore, a strong correlation was observed between the grades and durations of facial nerve palsy and meibomian gland dysfunction.

Familial exudative vitreoretinopathy (FEVR) is a rare inherited disorder of retinal angiogenesis. A 49-year-old male patient was referred to our clinic for retinal vascular occlusion. His history, clinical findings, and fundus fluorescein angiography findings were evaluated. Family members were called and eye examinations were performed. Our patient was not born preterm and he reported decreased visual acuity after a traffic accident during childhood. He had laser treatment when he was 12 years old and again 1 month before our examination. He also had laser-assisted in situ keratomileusis surgery for both eyes in 2002. On examination, his visual acuity was 0.4 in the right eye and 0.3 in the left eye. He had cortical cataract in both eyes. Macula OCT revealed macular contour irregularity due to epiretinal membrane in his right eye and minimal perifoveal thinning in his left eye. On fundus photography, straightening of the retinal vessels, macular dragging, retinal folds on temporal retina, preretinal fibrosis, and laser spots were seen. FFA revealed avascular retinal areas with incomplete laser spots in the temporal, inferior, and superior parts of retina. He also had neovascularization with leakage in the temporal retina of his right eye. The patient’s brother, who was also born at full term, also had excessive branching of the vascular structures in the temporal peripheral retina, non-perfused cord vessels and avascular areas. In light of all these findings, we diagnosed our patient with Stage 2A FEVR and his brother with Stage 1 FEVR. In summary, FEVR is a clinically diagnosed disease. Because FEVR is inherited and potentially sight-threatening, family examination is helpful and important so that affected family members can be diagnosed and followed up.

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