Meibography and corneal volume optical coherence tomography to quantify damage to ocular structures in children with blepharokeratoconjunctivitis

Abstract

Purpose To evaluate non‐contact infrared meibography and anterior segment optical coherence tomography (AS‐OCT) to detect meibomian gland (MG) and corneal changes in children with blepharokeratoconjunctivitis (BKC). Methods We acquired infrared meibography images of upper and lower lids and AS‐OCT corneal scans. One masked observer graded meiboscore, full/partial MG dropout, and measured total corneal volume and differential corneal volume per quadrant and central corneal thickness (CCT). Results We enrolled 63 children, 31 with BKC and 32 without ocular surface inflammation; median (interquartile range) age BKC 10.6 (7.2‐13.9) years, healthy volunteers (HV) 11.4 (9.5‐13.8) years. Likert scale scores for meibography and OCT indicate no to low discomfort. Meiboscores for upper and lower lids as well as the total meiboscore were significantly higher in children with BKC than in HV. Subscores for full and partial MG dropout were also significantly higher in children with BKC than in healthy volunteers. There was no statistically significant difference between upper and lower lid for meiboscore nor full/partial MG dropout scores. The corneal volume in the superior quadrant was significantly higher in children with BKC than in HV, whereas the corneal volume in the nasal and inferior quadrants was significantly lower. Conclusions Non‐contact imaging technologies objectively demonstrate damage to meibomian glands and changes in corneal volume secondary to BKC. The tests are well tolerated by children with mild/moderate ocular surface inflammation and can detect changes without the requirement for routine eversion of the upper lid. These parameters may be useful both for clinical follow‐up and clinical trials.

Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

“…PBKC is a severe ocular surface inflammatory condition affecting susceptible individuals early in life . Since the report from Viswalingam et al on the clinical relevance of the epidemiology, clinical features, and morbidity of children with Staphylococcal blepharokeratoconjunctivitis, the interest in PBKC has been reflected in increasing publications . The seriousness of the disease lies in its ability to cause considerable vision loss due to corneal damage .…”

Anterior segment optical coherence tomography meibography compared with keratograph meibography

“…6 However, there is evidence that AS-OCT has the potential for use as a diagnostic instrument for dry eye disease in tear film evaluation 8 and meibography. 9,10 The disadvantages of using this equipment are that it is expensive and requires expertise to use. Nevertheless, an advantage of AS-OCT is that it allows for 3D reconstruction as well as the production of 2D infrared images of the meibomian glands.…”

The influence of congenital and developmental cataract surgery on the ocular surface in a six-month follow-up prospective clinical study

“…Recent studies found that meibomian gland morphological changes, including meibomian gland atrophy and meibomian gland tortuosity, could begin in children without any symptoms [ 7 , 8 ]. Various ocular and systemic factors have been reported to influence meibomian gland morphology in children, including a higher body mass index (BMI) [ 7 ], blepharokeratoconjunctivitis [ 9 ], digital device usage [ 10 ], and environmental aggravation [ 8 ]. However, the effect of congenital/developmental cataract surgery on meibomian gland function has not been investigated.…”