Meibomian Gland Dysfunction in Mild versus Moderate-Severe Thyroid Eye Disease
Nasser Karimi1 *, Hossein Aghaei1 , Fatemeh Zarastvand1 , Parya Abdolalizadeh1 , Acieh Es’haghi1 , Mohsen Bahmani Kashkouli2
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
Abstract: Purpose: To compare meibomian gland (MG) loss and dysfunction (MGD) in patients with mild
versus moderate-severe thyroid eye disease (TED).
Methods: Consecutive patients with TED and no other causes of dry eye disease underwent
meibography and meiboscore of each eyelid was graded as 0 (no MG loss), 1 (<33% loss), 2 (33-
66% loss), and 3 (>66% loss) with a total score of 0-6. MG expression score (0-3), eyelid margin
signs of MGD, lipid layer thickness (LLT), Ocular surface disease index (OSDI), tear secretion,
tear break-up time (NITBUT), and tear meniscus height (TMH) were also assessed by a masked
observer.
Results: Included were 21 eyes (21 patients) with mild and 19 eyes (19 patients) with moderate-
severe TED. Two groups were not different except for a higher frequency of smoking (P<0.01).
Eyes with moderate-severe TED showed a higher upper eyelid meiboscore (P=0.03), MG
expression score (P<0.01), and tear film osmolality (P=0.02) as well as lower LLT (P=0.03).
2
Total meiboscore had a significantly positive correlation with OSDI (r s =0.37) and tear film
osmolality (r s =0.50) as well as negative correlation with NITBUT (r s =-0.55), TMH (r s =-0.44),
and LLT (r s =-0.38). While older age, male gender, smoking, and longer duration of disease were
significantly associated with the higher (≥3) meiboscore in univariate analysis, none remained
significant in multivariate analysis.
Conclusion: MG loss and MGD were significantly more severe in moderate-severe than mild
TED.
