In vivo confocal microscopy of meibomian glands in primary blepharospasm

Abstract

The aim of the study was to evaluate the morphological changes of meibomian glands (MGs) in primary blepharospasm (PBS) by in vivo laser scanning confocal microscopy (LSCM) and to investigate the correlations between clinical data of PBS and LSCM parameters of MGs. This prospective and case–control study recruited 30 consecutive PBS patients and 30 age- and gender-matched healthy controls. After questionnaire assessments of ocular surface disease index (OSDI), Jankovic rating scale, and blepharospasm disability index, all subjects underwent blink rate evaluation, tear film break-up time (TBUT), corneal fluorescein staining (CFS), Schirmer test, MG expressibility, meibum quality, MG dropout, and LSCM examination of the MGs. The main LSCM outcomes included the mean MG acinar area and density, orifice diameter, meibum secretion reflectivity, acinar irregularity, and inhomogeneity of interstice and acinar wall. The PBS patients had significantly higher blink rate, higher OSDI and CFS scores, lower TBUT and Schirmer test value, and worse MG expressibility than the controls (All P 0.05), whereas meibum quality showed no difference (P > 0.05). The PBS patients showed lower values of MG acinar area, orifice diameter and meibum secretion reflectivity, and higher scores of acinar irregularity and inhomogeneity of interstices than the controls (All P < 0.05). For the PBS patients, the severity of blepharospasm evaluated by JCR scale was strong correlated with MG acinar area (P < 0.001), orifice diameter (P = 0.002), meibum secretion reflectivity (P = 0.002), and MG acinar irregularity (P = 0.013). The MG expressibility was significantly correlated to MG acinar area (P = 0.039), orifice diameter (P < 0.001), and MG acinar irregularity (P = 0.014). The OSDI score was moderate correlated with MG acinar irregularity (P = 0.016), whereas the TBUT value was positively correlated with MG acinar area (P = 0.045) and negatively correlated to MG acinar irregularity (P = 0.016). The CFS score was negatively correlated to MG orifice diameter (P = 0.008). The LSCM provided a noninvasive tool for in vivo histopathologic studies of MGs in PBS patients. The excessive constriction of lid muscles closely related to MG morphological alterations of PBS, which offered a new research approach to interpret the interactional mechanism between dry eye and PBS.

Changes in the tarsal conjunctiva viewed by in vivo confocal microscopy are associated with ocular symptoms and contact lens wear

“…This was broadly the case, as both parameters indicated that soft CL wear produced a more rounded and regular papillae shape. In the literature, Lin and Gong reported a value of 1.00 (0.45) in non‐wearers, which noticeably differs from our group of non‐wearers; however, differences between both groups, such as the considerably different age, make that both groups were not comparable. Besides, being an objectively measure quantity, circularity does appear to possess an advantage in terms of offering greater precision and hence, superior power during statistical analysis.…”

“…In the current study, three images from the central lid region as close to the centre as possible were collected, although slight displacements might have occurred due to the size of the tomocap and any move or blink. The number of images is consistent with some previous work, however it is acknowledged that up to nine images, from three different regions (nasal, central and temporal) have been used by others . This may explain some of the variance in the results between studies.…”

“…In addition, papillae irregularity was graded according to the scale (0–3, in 1 unit steps) reported by Lin and Gong; and papillae reflectivity, inhomogeneous appearance of wall, and inhomogeneous appearance of rete ridges were evaluated using the scales (1–4, in 1 unit steps) reported by Villani et al …”

In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves’ orbitopathy

“…The following variables were quantitatively determined [32,35]: (1) MG ori ce area (MOA; calculated automatically by ImageJ software, National Institutes of Health, Bethesda, MD, USA), (2) MG acinar density (MAD; acini were manually marked inside each 400*400-µm frame and the density was automatically calculated using the HRT III cell counting system), (3) MG acinar longest diameter (MALD), (4) MG acinar shortest diameter (MASD), (5) MG acinar irregularity (MAI), (6) meibum secretion re ectivity (MSR), (7) acinar wall inhomogeneity (AWI), (8) acinar periglandular interstices inhomogeneity (API), and (9) severity of MG brosis (MF). The MAI was assessed on a 4-point scale, with virtually round or elliptical shape as 0, minimal presence of lobulated shaped acinar units as 1, moderate presence as 2 and heavy presence as 3 [36]. The MSR was evaluated on a 4-point scale [36][37][38][39]: black secretion color was scored as 0, dark gray color as 1, light gray color as 2, and white color as 3.…”

“…The MAI was assessed on a 4-point scale, with virtually round or elliptical shape as 0, minimal presence of lobulated shaped acinar units as 1, moderate presence as 2 and heavy presence as 3 [36]. The MSR was evaluated on a 4-point scale [36][37][38][39]: black secretion color was scored as 0, dark gray color as 1, light gray color as 2, and white color as 3. The AWI and API were each rated on a 4-point scale: absence of punctate re ecting elements was scored as 0, minimal presence of punctuate re ecting elements as 1, moderate presence as 2, and heavy presence as 3 [36][37][38][39].…”