The Association Between Risk Factors for Metabolic Syndrome and Meibomian Gland Disease in a Dry Eye Cohort

Abstract

Purpose: Risk factors for metabolic syndrome include abdominal obesity, insulin resistance, hypertension, high triglycerides and/or low high-density lipoprotein cholesterol, and hyperglycemia. Risk factors for metabolic syndrome have been associated with dry eye disease; however, their association with meibomian gland disease (MGD), a subtype of dry eye, is unclear. In the present study, we investigated risk factors for metabolic syndrome in a dry eye cohort with and without MGD. Methods: This retrospective case-control study evaluated electronic medical records at a major urban outpatient medical center to identify patients with a known diagnosis of dry eye disease with and without MGD. Males and females were matched for age, smoking status, race, ethnicity, and body mass index (BMI). Patient demographics, anthropometric measurements, medical history, clinical findings, and serologies were analyzed. A diagnosis of MGD was based on clinical signs noted in the medical record. Results: MGD was not associated with BMI, smoking, type 2 diabetes mellitus, hypertension or hyperlipidemia in this dry eye cohort. MGD was associated with male sex and increasing age. While increasing age was weakly correlated with decreased low density lipoprotein cholesterol and non-high density lipoprotein cholesterol, serum lipid levels were not associated with MGD. Conclusion: Importantly, we found that risk factors for metabolic syndrome are not specifically associated with an increase in MGD when compared to non-MGD dry eye subjects. While risk factors for metabolic syndrome are associated with dry eye disease, they likely reflect a chronic systemic state of low-grade inflammation that negatively impacts the function of both lacrimal and meibomian glands.

Association of Serum Lipid Level with Meibum Biosynthesis and Meibomian Gland Dysfunction: A Review

“…Nine of the selected clinical research articles investigated the association between serum lipid levels and MGD [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. All nine articles showed evidence of Level 3 as a cross-sectional case–control study.…”

“…Six of the nine articles [ 20 , 21 , 22 , 23 , 24 , 25 ] compared the mean serum lipid level and the prevalence of patients with dyslipidemia between patients with MGD and controls. Most studies showed a higher prevalence of abnormal serum lipid profiles among patients with MGD than controls; however, there were also controversial results as well.…”

“…Compared with the rest of the studies [ 20 , 21 , 22 , 23 , 24 ] with a relatively small number of subjects (58 to 136 subjects), Ha et al [ 25 ] conducted a much larger cohort study in which authors employed age and sex-matched propensity score matching using normal control patients from the National Health and Nutrition Examination Survey (NHANES).…”

“…Except for two recently published articles [ 24 , 25 ], the study by Pinna et al [ 20 ], Braich et al [ 21 ], Chen et al [ 22 ], and Irfan et al [ 23 ] performed multivariate regression analysis to analyze risk factors for MGD, and the results were varied.…”

“…The association between serum lipids and MGD can be analyzed in direct and indirect ways. Altering the lipid composition in the blood Level 1n dyslipidemia and MGD has shown conflicting results that cholesterol and LDL, and HDL may or may not be related to MGD [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. There is no Level 1 evidence of the association between MGD and serum lipid levels.…”