Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss

Arita, Reiko; Morishige, Naoyuki; Koh, Shizuka; Shirakawa, Rika; Kawashima, Motoko; Sakimoto, Tohru; Suzuki, Takashi; Ohta, Michio

doi:10.1016/j.ophtha.2014.12.018

Cited by 124 publications

(109 citation statements)

References 37 publications

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“…In our study, increased evaporation was indicated by elevated tear film osmolarity despite higher tear production than in control subjects. Raised tear production is probably a compensatory mechanism in MGD 22. Hence, MGD appeared to be associated with DED in aniridia.…”

Section: Discussionmentioning

confidence: 94%

Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

et al. 2018

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Section: Discussionmentioning

confidence: 94%

Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

et al. 2018

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“…We have previously shown that tear fluid secretion is increased in individuals with MGD, suggesting that such secretion increases to compensate for the reduced production of the lipid layer. 21 We have now found that LLT tended to be increased in subjects with reduced tear fluid secretion, suggesting that production of the lipid layer increases to compensate for the reduced volume of tear fluid. Given that the condition of the tear film is thought to be dynamic, such compensation would also be expected to be dynamic.…”

Section: Discussionmentioning

confidence: 72%

“…5,11,17,[19][20][21] We have now evaluated the overall aqueous and lipid kinetics of the tear film, as well as measured the thickness of the lipid layer by tear interferometry, revealing the balance between the lipid and aqueous layers of the tear film, 11,15,22,23 in individuals with dry eye disease. Our results indicate that the interferometric color and fringe patterns associated with tear film stability reflect the balance between the aqueous and lipid layers of the tear film, and they suggest that these patterns are able to identify subtypes of dry eye.…”

Section: Discussionmentioning

confidence: 99%

Tear Interferometric Patterns Reflect Clinical Tear Dynamics in Dry Eye Patients

Arita

Morishige

Fujii

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We investigated whether the tear interferometric pattern was able to identify differences in tear film kinetics among clinical subtypes of dry eye. METHODS.A total of 138 eyes of 76 subjects (38 men and 38 women; mean age 6 SD, 61.6 6 16.2 years) with or without dry eye who visited Itoh Clinic from May to August 2015 were enrolled in a cross-sectional study. Clinical diagnosis of dry eye subtype was based on tear film parameters. The pattern of tear film kinetics determined by interferometry was classified as 0 (monotonous gray or multicolor interferometric fringe with a noninvasive breakup time [NIBUT] of ‡5 seconds), 1 (multicolor interferometric fringe with a NIBUT of <5 seconds), or 2 (grayish amorphous interferometric fringe with a NIBUT of <5 seconds), and reliability of classification was evaluated. Lipid layer thickness (LLT) for the tear film was also determined by interferometry. RESULTS.Interrater j values for evaluation of interferometric patterns ranged from 0.57 to 0.94 for both physicians and nonphysicians with reference to a dry eye expert, the latter of whom showed an intrarater reliability of 0.90. The distribution of eyes among interferometric patterns 0, 1, and 2 coincided well with the clinical subgroups of normal tear condition, nonSjögren syndrome aqueous-deficient dry eye, and meibomian gland dysfunction, respectively. A multicolor interferometric fringe was essentially observed only at an LLT of >70 nm. CONCLUSIONS.Tear interferometry was able to reliably distinguish clinical subtypes of dry eye by reflecting the balance between the lipid and aqueous layers of the tear film.Keywords: tear interferometry, dry eye, meibomiangland T he tear film consists of aqueous, mucin, and lipid layers with different levels of complexity.1 The quality and quantity of each layer, as well as their interactive relations, are important for homeostasis of the tear film. Impairment of the quality or changes in the quantity of tear film components can result in dry eye disease, which is categorized as either aqueous-deficient dry eye (ADDE) or evaporative dry eye (EDE).2,3 Dysfunction or hypofunction of lacrimal glands and the consequent reduced volume of the aqueous layer of the tear film thus underlie ADDE. Similarly, dysfunction or hypofunction of meibomian glands (which produce the lipid components of the tear film) or reduced production of mucin proteins by conjunctival goblet cells increases the evaporation of tear fluid and results in EDE.Interferometry has been applied as a noninvasive method for visualization of the lucent lipid layer at the surface of the tear film. 4 Tear interference images associated with surface phenomena of the tear film have thus been obtained 5-8 based on a principle first described by Newton. 9 This approach has been adopted to study tear dynamics in individuals with Sjögren syndrome 10 or dry eye, 11 including EDE, 12 as well as in contact lens wearers. 6,13 It has also been used to measure the thickness of the lipid layer of the tear film in normal subjects, 14 in...

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“…Expressibility of meibomian glands is one of the most important functional tests in diagnosing MGD and is negatively correlated with the meibomian gland atrophy 33. Correlation between meibomian gland dropout and Schrimer’s test score in patients with MGD suggests that tear fluid secretion may increase as a compensatory response of the loss of tear film stability due to the deficiency of the lipid layer 34. Meibography also provides detailed morphological assessment of the meibomian glands.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Advances in dry eye imaging: the present and beyond

et al. 2017

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New advances in imaging allow objective measurements for dry eye as well as define new parameters that cannot be measured by clinical assessment alone. A combination of these modalities provides unprecedented information on the static and dynamic properties of the structural and functional parameters in this multifactorial disease. A literature search was conducted to include studies investigating the use of imaging techniques in dry eye disease. This review describes the application of non-invasive tear breakup time, optical coherence tomography, meibomian gland imaging, interferometry, in vivo confocal microscopy, thermography and optical quality assessment for this condition.

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Increased Tear Fluid Production as a Compensatory Response to Meibomian Gland Loss

Abstract: An increase in tear fluid production likely compensates for loss of meibomian glands in individuals with MGD.

Cited by 124 publications

References 37 publications

Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia

Tear Interferometric Patterns Reflect Clinical Tear Dynamics in Dry Eye Patients

Advances in dry eye imaging: the present and beyond

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