Noncontact Meibography in Patients with Keratoconus

Abstract

Purpose. To examine the morphological changes in the meibomian glands of patients with keratoconus as well as to study the relationship between these changes in the morphology and several tear film parameters. Methods. Examination of the meibomian gland (MG) of 300 keratoconus patients presenting to the center using infrared noncontact meibography system (Sirius, CSO, Italy) between January 2017—January 2019. 100 eyes of healthy individuals were also enrolled as a control group. Tear breakup time (TBUT) test and Schirmer test II were evaluated. Subjective symptoms were also assessed using Ocular Surface Disease Index (OSDI). Results. Mean age of keratoconus patients was 19 ± 12 years and 21 ± 14 years in control group. Average TBUT was 4.9 ± 2.1 sec. and average Schirmer test was 5.3 ± 2.2 mm which was significantly lower than control group (p=0.05). Meibomian gland dropout in the lower eyelid of the keratoconus group was as follows: grade 0 (no loss of meibomian glands): 100 eyes; grade 1 (gland dropout area <1/3 of the total meibomian glands): 85 eyes; grade 2 (gland dropout area 1/3 to 2/3): 68 eyes; and grade 3 (gland dropout >2/3): 47 eyes. Conclusion. Keratoconus shows significant meibomian gland dropout and distortion that can be recorded by noncontact meibography. Sirius meibography is a simple, cost-effective method of evaluating meibomian gland dropout as a part of the routine refractive examination.

Morphological and Functional Assessment of Meibomian Glands in Keratoconus

“…Keratoconus is a multifactorial disease with genetic, environmental, in ammatory, hormonal risk factors and eye rubbing playing role in etiopathogenesis [17]. In the literature, few studies reported on increased dry eye symptoms [7,18], tear lm instability [6,19], ocular surface staining [6, 7] and conjunctival metaplasia with goblet cell loss in keratoconus patients [5][6][7]. indicating involvement of whole ocular surface epithelium and tear lm in the disease process in these eyes.…”

Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study

“…Some studies have found that subjects with irregular corneas are more likely to suffer from DED and MGD [42][43][44]. Moreover, McMonnies [61] and Lema et al [62] also suggested that a possible inflammatory role might be involved in the pathogenesis of keratoconus since inflammatory molecules were overexpressed in the tears of subjects with keratoconus.…”

“…The sample of this study represented irregular corneas, except for four of them. Since scleral lenses are usually fitted in subjects with irregular corneas, who are more likely to suffer from DED [42][43][44], assessing the effect of these lenses on meibomian glands is vital. Thus, a recent review confirmed that there is a need for prospective evaluation of meibomian gland appearance and function during scleral lens wear [11].…”

“…Moreover, it has been recognized the need for assessing meibomian glands in subjects fitted with these lenses [41]. Since scleral lenses are usually fitted in subjects with irregular corneas, namely patients with keratoconus who are more likely to suffer from DED and MGD [42][43][44], understanding their effect on meibomian glands is clinically relevant. The present study has two main aims: The first one is to validate a previously developed algorithm based on the visibility of meibomian glands with a commercial fundus camera, which might help to further validate this algorithm, suggesting that it is not instrumentspecific.…”

Evaluation of Corneal Parameters and Meibomian Gland Alterations After Corneal Cross-Linking in Patients With Progressive Keratoconus

“…11–13 Evaluating dry eye parameters in KC patients revealed low tear break-up time (TBUT) and marked corneal staining, increased the Ocular Surface Disease Index© (OSDI) scores, dropout, and distortion in MGs. 8,14–16…”