Search Results (66)

Objectives: To investigate the clinical characteristics of patients with meibomian gland dysfunction (MGD) who are refractory to additional intense pulsed light (IPL) treatment. Materials and Methods: This retrospective study included 66 eyes of 66 patients with moderate-to-severe MGD who had previously undergone four sessions of IPL treatment with a 590 nm filter at another clinic and, received an additional four sessions of IPL treatment with a vascular filter. Patients’ subjective assessments before and after the additional IPL treatments were scored on a scale from 0 to 4, where 0 = moderate improvement, 1 = mild improvement, 2 = no change, and 3 = aggravated MGD. Patients who scored 0 or 1 were classified as Group 1 (Responsive group), while those who scored 2 or 3 were classified as Group 2 (Refractory group). Results: Among the 66 eyes from 66 patients, Group 1 comprised 32 eyes and Group 2 comprised 34 eyes. Patients in the refractory group, who did not respond to additional IPL treatment, exhibited poor ocular staining scores before additional IPL treatment. The responsive group showed better treatment responses with regard to the Oxford and Sjögren’s International Clinical Collaborative Alliance (SICCA) staining scores (all p < 0.001), upper and lower lid meibum quality and meibum consistency, and meibomian gland grade (all p < 0.001). Changes in the Oxford staining score (p = 0.032), SICCA staining score (p = 0.003), meibum quality (p < 0.001), meibum consistency (p < 0.001), and meibomian gland grade (p < 0.001), before and after the additional treatment, were significantly greater in Group 1 than in Group 2. Conclusions: Additional IPL treatment with a vascular filter may provide further clinical benefits in selected patients with moderate-to-severe MGD who have previously undergone IPL therapy. Poor baseline ocular surface staining was associated with a lower likelihood of treatment response and may help identify patients who are less likely to benefit from additional IPL treatment. Full article

Background/Objectives: Dry eye disease (DED) is a multifactorial disorder characterized by tear film instability, inflammation, and ocular surface damage, which significantly impairs visual function and quality of life. Conventional ophthalmic formulations, such as eye drops, have low bioavailability owing to rapid elimination, necessitating frequent administration. In this study, we developed an eyelid-applied drug delivery system (DDS) based on troxipide (TRO) nanoparticle formulation (TRO-NP@EG) to achieve sustained ocular surface delivery. Methods: TRO nanosuspensions were prepared by wet bead milling and incorporated into a Carbopol-based gel. Particle size, dispersion stability, and uniformity were evaluated, and in vitro drug release studies was compared with that of TRO-MP@EG. In vivo drug transfer into tear fluid was assessed in rabbits following eyelid application, and therapeutic efficacy was evaluated in an N-acetylcysteine-induced dry eye model. Results: TRO nanosuspensions had a mean particle size of approximately 118 nm. TRO-NP@EG exhibited superior dispersion stability and uniformity and achieved 2.5-fold higher drug release than TRO-MP@EG, while the nanoparticles remained in solid form. In vivo studies in rabbits, TRO-NP@EG significantly enhanced drug transfer into tear fluid, primarily via the meibum pathway. Furthermore, TRO-NP@EG significantly improved mucin levels, tear secretion, and tear film stability compared with TRO-MP@EG in an N-acetylcysteine-induced dry eye model. Conclusions: These findings suggest that eyelid application of nanoparticle-based formulations enables efficient and sustained drug delivery to the ocular surface via the meibomian glands. Therefore, TRO-NP@EG represents a promising therapeutic strategy for DED, providing enhanced efficacy and a novel route of administration for ophthalmic DDSs. Full article

Environmental stressors like low temperature, low relative humidity (RH), and particulate matter (PM2.5), promote tear film instability and dry eye disease. This study investigates how these conditions alter the interfacial behavior of meibomian gland secretion (MGS) films in vitro and evaluates the capacity of mucomimetic polymers (0.5% hyaluronic acid [HA], polyvinylpyrrolidone [PVP], and chondroitin sulfate [CHS]) to suppress these impacts. MGS films over polymer-containing aqueous subphases were analyzed using a Langmuir trough and Brewster angle microscopy under adverse conditions (20 °C subphase, 20% RH, PM2.5 exposure). A sophisticated analytical framework was developed to evaluate MGS duplex multilayers: (i) a Volmer equation-based 2D-VES model to probe interfacial molecular properties (limiting area, compressibility, cohesion pressure) and (ii) a combined Maxwell viscoelastic and diffusion-relaxation model to quantify the dilatational relaxation modulus. Results indicate that despite their distinct nature, environmental stressors similarly disrupt the multilayer structure, reorganization, and rheological properties of MGS layers during blink-like deformations. Polymer supplementation moderated these adverse effects, yielding partial recovery of film structure and isothermal reversibility. Distinct mechanisms of action for HA, PVP, and CHS at the film/aqueous interface are elucidated. Full article

Background/Objectives: This review considered meibomian gland functional assays, reported in recent dry eye treatment trials, that have potential as a clinical/physiological measure in a Core Outcome Set in dry eye clinical trials. The focus was on clinical methods that can be applied globally by trained clinicians. Methods: An electronic search of the MEDLINE database (via PubMed) was conducted to identify randomized controlled trials published in English between 1 January 1995 and 11 December 2025. The search strategy used the terms (meibomian OR meibography) AND treatment. Studies were included if they reported outcomes related to meibum secretion and/or meibomian gland expressibility in human participants. Moreover, a retrospective chart review was undertaken from previously unpublished meibum grading data to determine whether opacity and viscosity grades for meibum are correlated. Results: 98 studies were included for analysis The grading systems of Bron and co-workers, combined with that of the similar MGD Workshop report, were the most prevalent (n = 48), followed by Lane and co-workers (n = 23) and Shimazaki and co-workers (n = 10). Expressibility grading systems were most prevalent for Pflugfelder et al. (n = 33), followed by Blackie-Korb (n = 19) and Author defined (n = 17). The retrospective analysis of 69 charts suggests high correlation between meibum opacity and viscosity (Pearson’s r = 0.904, p < 0.001. 95% CI 0.849–0.940). Conclusions: Grading meibum quality is important in dry eye diagnosis and treatment. A modification of the MGD Workshop system appears useful as a core outcome set parameter in dry eye treatment trials. Full article

Purpose: To evaluate the clinical efficacy and safety of eye drops containing lyophilized amniotic membrane (AM) in the treatment of dry eye disease (DED), with a focus on tear film stabilization and epithelial–immune balance. Methods: In this prospective cohort study, 40 patients (80 eyes) with DED were followed over six visits. The primary outcome was tear break-up time (TBUT). Secondary outcomes included corneal and conjunctival staining graded by the Oxford scale, meibomian gland parameters, corneal sensitivity (Cochet–Bonnet esthesiometry), best-corrected visual acuity, intraocular pressure (IOP), and Schirmer I test. Continuous variables were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction and Bonferroni post hoc testing; ordinal outcomes were analyzed using the Friedman test with Dunn–Bonferroni correction. Results: TBUT increased significantly in both eyes (OD: +5.3 s; OS: +4.9 s; both p < 0.001; ηp² ≈ 0.33). Corneal and conjunctival staining scores decreased (p < 0.001), meibomian gland quality and expressibility improved (p < 0.001), and corneal sensitivity increased (p < 0.001), while visual acuity and IOP remained stable. Schirmer I values showed no significant change. The combined pattern of changes (TBUT ↑, staining ↓, meibum/expressibility ↑, sensitivity ↑) indicates tear film stabilization and ocular surface improvement with a preserved safety profile. Conclusions: Lyophilized AM eye drops significantly prolong TBUT and improve clinical signs of DED, presumably by restoring the extracellular matrix (ECM) niche and the heavy-chain hyaluronan/pentraxin 3 (HC-HA/PTX3) complex, reducing proteolytic burden, and promoting a pro-resolving immune balance, with potential neurotrophic effects. These findings support the adjunctive use of AM-derived eye drops within contemporary TFOS DEWS II-based management algorithms for dry eye disease. Full article

Background/Objectives: Lipid layer thickness (LLT) is widely used to assess tear film status in dry eye disease (DED), but single-point measurements may not adequately reflect spatial lipid distribution driven by tear film dynamics. This study evaluated whether the combined assessment of inferior and superior corneal LLT provides additional clinical relevance for interpreting DED subtypes. Methods: This cross-sectional study included 614 eyes of 614 patients with DED. Inferior corneal LLT (LLT_inf) was measured using a tear interferometer, and superior corneal LLT (LLT_sup) was graded using an LED-based slit-lamp assessment. DED parameters, including meibomian gland expressibility (MGE), meibum quality, tear meniscus height, Schirmer I test, and fluorescein tear break-up patterns, were analyzed. Results: Low LLT_inf showed worse meibomian gland function, with higher MGE scores than in the high LLT_inf group (1.9 ± 0.8 vs. 1.2 ± 0.9, p < 0.001). Higher LLT_inf was associated with lower aqueous parameters, and aqueous deficiency was observed in 57.4% of the high LLT_inf group increasing to 83.0% when LLT_sup was low. Combined LLT_inf–LLT_sup assessment improved the prediction of aqueous deficiency compared with LLT_inf alone (AUC, 0.719 vs. 0.559). Improvement for moderate-to-severe MGD was smaller (AUC 0.731 vs. 0.653). Conclusions: LLT reflects not only lipid secretion, but also aqueous-driven distribution. The combined assessment of LLT_inf and LLT_sup may improve the interpretation of LLT findings and provide additional insight into tear film dynamics in DED. However, its predictive performance remains moderate, suggesting that this approach is considered a complementary interpretive framework rather than a standalone diagnostic tool. Full article

Background/Objectives: As scleral lens (SL) use continues to expand, particularly for medically necessary management of corneal irregularity and ocular surface disease, it is important to determine if wear of these lenses is associated with eyelid disease. This study evaluated habitual SL wearers for meibomian gland obstruction, meibum quality, and signs of lid margin inflammation. Methods: Eligible participants wore scleral lenses in one or both eyes for any indication and had been wearing their current lens design(s) for at least six months, with habitual wear of ≥5 h per day, six days per week. Eyelid inflammation metrics were specifically assessed. Results: Forty-nine scleral lens wearers (32 females) were enrolled. Upper lid wiper epitheliopathy (LWE) was present in 21 eyes (43%), and lower LWE was present in 15 eyes (31%). Thirty-nine eyes (80%) had expressible meibomian glands. Eyes with no expressible meibum were significantly higher in ocular surface disease (39%, 7/18) than corneal irregularity (11%, 3/27) (p = 0.03). Lid margin telangiectasia was present in wearers with ocular surface disease (61%, 11/18) and corneal irregularity (19%, 5/26) (p = 0.005). Conclusions: Eyelid disease was common among habitual scleral wearers regardless of indication for lens use. Eyes with ocular surface disease demonstrated a higher prevalence of meibomian gland obstruction and lid margin telangiectasia compared to those with corneal irregularity. Full article

Background/Objectives: To evaluate the relationships between meibomian gland dysfunction (MGD), ocular surface parameters, and matrix metalloproteinase-9 (MMP-9)-mediated inflammation in glaucoma patients, we specifically assessed the impact of prostaglandin analogue use, preservative exposure, and number of medications. Methods: This retrospective cross-sectional study included patients treated with topical antiglaucoma medications for at least six months. Meibomian gland expressibility, meibum quality, and MGD grade were assessed along with tear film break-up time (TBUT), Schirmer I test, and Oxford staining score. Tear MMP-9 levels were measured using a Point-of-Care immunoassay (InflammaDry^®) and graded on a 0 to 4 scale. Results: Elevated MMP-9 grades were significantly correlated with worsening meibum expressibility, meibum quality, and MGD grade (all p < 0.001), whereas no significant associations were found with traditional parameters such as TBUT and Schirmer I test. Prostaglandin analogue use was associated with worse meibomian gland parameters and higher MMP-9 levels compared to non-use. Patients receiving preservative-containing medications exhibited poorer meibomian gland parameters and MMP-9 levels, as well as worse corneal staining scores. An increased number of medications was associated with a stepwise deterioration in meibomian gland function and elevated MMP-9 levels. Conclusions: Prostaglandin analogue use, preservative exposure, and increased number of medications are significant factors associated with the exacerbation of MGD and ocular surface inflammation. Semi-quantitative grading of tear MMP-9 revealed a stepwise association with meibomian gland dysfunction severity that was not detected by conventional dry eye metrics, indicating that MMP-9 may be considered a potential indicator of subclinical ocular surface inflammation in glaucoma patients. Full article

Environmental stressors such as low temperature, low relative humidity (RH), and airborne particulate matter (PM2.5) can promote tear film (TF) instability and dry eye disease. Because the lipid layer is the first TF component exposed to these challenges, this study investigates how such conditions alter the interfacial behavior of meibomian gland secretion (MGS) films in vitro. A second objective is to evaluate the capacity of Rohto Dry Aid (RDA), a tear-mimetic nanoemulsion, to suppress the impact of environmental stressors on MGS. Pseudobinary MGS/RDA films were studied with a Langmuir trough and Brewster angle microscopy to assess molecular-level interactions at the air–water interface under adverse ambient conditions, including 20 °C aqueous subphase, 20% RH, and PM2.5 exposure. It was found that despite their distinct nature, the environmental stressors exert similar impacts, disrupting the multilayer structure and the reorganization and rheological properties of MGS layers at blink-like area deformations. These adverse effects were moderated by the supplementation with RDA which resulted in partial recovery of the mebomian film structure and isothermal reversibility. Thus, although they cannot fully replicate the complexity of native meibum, tear-mimetic nanoemulsions represent a potent tool to mitigate the impact of environmental stressors on tear film functionality. Full article

This study evaluated the efficacy of the TOF-SIMS (time-of-flight secondary ion mass spectrometry) technique for the comprehensive lipidomic analysis of human meibum, a lipid-rich secretion essential for tear film stability, using samples collected from ten participants. The applied methodology proved effective in characterizing the complex chemistry of meibum, confirming the presence of diverse lipid classes, including fatty acids, sterols, and glycerolipids. Multivariate and pairwise statistical analyses, including permutational multivariate analysis of variance (PERMANOVA) and maximum mean discrepancy (MMD),confirmed the significant compositional difference between the two groups. Principal component analysis (PCA) revealed a clear separation between the samples, driven primarily by an elevated ratio of monounsaturated fatty acids (C18:1, C16:1) to cholesterol in the group with MGD compared to healthy controls. These findings demonstrate the utility of TOF-SIMS coupled with multivariate analysis for detecting disease-specific molecular alterations in meibum, highlighting its potential for differentiating ocular surface pathologies. Full article

Meibum—a lipid-rich secretion produced by holocrine Meibomian glands (MG)—plays a central role in maintaining ocular surface homeostasis in humans. Previously, changes in MG lipidomes induced by inactivation of critical genes of meibogenesis, such as Elovl3, Soat1, Awat2, Sdr16c5/Sdr16c6, and others were shown to cause MG dysfunction (MGD) and dry eye in experimental animals. Here, we describe the impact of the changes in the lipid composition of meibum on its protective properties, specifically physiologically relevant thermotropic characteristics, using various mutant and wild-type animal models, and comparing them with healthy human subjects and patients with MGD. Meibum samples were analyzed using liquid chromatography/mass spectrometry (LC/MS) and differential scanning microcalorimetry (DSC). We found that any change in the balance between major lipid classes in meibum—wax esters, cholesteryl esters, triacylglycerols, and free cholesterol—cause detrimental changes in its thermotropic properties, loss of cohesiveness, and abnormal expressibility from MG, resulting in MGD-like phenotypes of the eyes and adnexa. We conclude that tested knockout mice can be valuable models for modeling and studying MGD. A combination of LC/MS and DSC can be a powerful diagnostic tool and may help to diagnose MGD and other pathologies, as well as determine their molecular mechanisms. Full article

Purpose: The aim of this study was to evaluate the different approaches used in the treatment of meibomian gland dysfunction (MGD). Materials and Methods: This open-label, single-center, prospective pilot study with a parallel-group design was conducted in February 2025. Ninety-two patients presenting to our clinic with symptoms and signs of MGD were enrolled and diagnosed according to Japanese MGD diagnostic criteria. Patients were assigned to five treatment groups: conservative management alone, conservative management plus intense pulsed light (IPL) therapy, conservative management plus oral azithromycin, conservative management plus oral doxycycline, and conservative management plus topical cyclosporine. Conservative management consisted of preservative-free artificial tears containing polyvinyl alcohol and povidone, warm compresses, and eyelid hygiene. Primary outcome measures included ocular surface parameters such as the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Standard Patient Evaluation of Eye Dryness (SPEED) scores, and meibomian gland parameters evaluated using a slit-lamp examination. All parameters were assessed at baseline and during follow-up examinations after treatment initiation to observe changes in symptoms and signs. Results: A statistically significant increase was determined in meibum grade plugging (grades 0–3; higher = greater obstruction) and Marx line scores with IPL therapy (p < 0.05). The group receiving doxycycline treatment exhibited a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. The group receiving cyclosporine registered a significant improvement in OSDI and SPEED scores, plugging, TBUT, and meibum grades. A statistically significant increase was observed in the conservative treatment group in terms of lid margin irregularity, Marx line score, and OSDI and SPEED scores. In the group receiving azithromycin treatment, plugging, lid margin irregularity, TBUT, and OSDI and SPEED scores increased significantly. Compared with conservative care, the doxycycline group exhibited lengthened TBUT and lowered meibomian gland plugging and symptoms (p < 0.05), and the oral azithromycin group achieved a similar TBUT gain with slightly greater symptom relief. The topical cyclosporine group principally registered improved lid vascularity and meibum quality (p < 0.05), while the IPL group achieved the greatest overall improvements, reducing plugging and Marx line scores and adding ≈3 s to TBUT (p < 0.05 for all endpoints). Doxycycline exhibited notable short-term improvements, with 35.26% meibum grade improvement and a 40.48% foaming response, while IPL therapy demonstrated substantial OSDI improvements at 54.06%, with traditional parameters indicating limited treatment responsiveness. Conclusions: Various methods can be used in the treatment of MGD. All the conservative treatment methods used in this study were successful. Full article

This study aims to compare meibomian gland (MG) dropout and MG dysfunction (MGD) between patients with diabetes mellitus (DM) with moderate–severe non-proliferative diabetic retinopathy (NPDR) and patients with no diabetes (NDM). This prospective, transversal, age, and gender-matched case–control study included 98 DM and 106 NDM eyes. Dry eye disease (DED) and MGD evaluations were performed, including meibography (Keratograph 5M^®). The objective MG dropout percentage was obtained by analyzing meibography images with ImageJ software (v. 1.52o, National Institutes of Health, Bethesda, MD, USA) and was subsequently graded with Arita’s meiboscore. The DM duration was 18 ± 9 years. The mean meiboscore (3.8 ± 0.8 vs. 3.4 ± 1.0, p = 0.001), meiboscore severity (p = 0.016), and MG dropout (45.1 ± 0.1% vs. 39.0 ± 0.4%, p < 0.001) were greater in DM than in NDM. All patients showed MG dropout (meiboscore > 1). Lower eyelids showed greater MG dropout in both groups. A correlation with age (r = 0.178, p = 0.014) and no correlations with DM duration or gender (p > 0.005) were observed. Patients with diabetes showed greater corneal staining (1.7 ± 1.3 vs. 0.9 ± 1.1; p < 0.001), reduced corneal sensitivity (5.4 ± 1.1 vs. 5.9 ± 0.4; p < 0.001), lower MG expressibility (3. 9 ± 1.6 vs. 4.4 ± 2.1; p = 0.017), and worse meibum quality (1.9 ± 0.8 vs. 1.7 ± 0.5; p = 0.019). Tear breakup time, osmolarity, MMP-9, Schirmer, and the Ocular Surface Disease Index showed no significant differences. In conclusion, patients with DM with NPDR have greater MG dropout and meiboscore, as well as more severe MGD and DED parameters than persons with NDM. Full article

We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users. Full article

Background: To determine the differences in the effects of intense pulsed light (IPL) treatment when including the upper and lower lid or lateral canthus area in patients with meibomian gland dysfunction (MGD). Methods: Patients who underwent three IPL treatment sessions at 3-week intervals were divided into three groups according to the treatment sites: group A, lower lid; group B, upper and lower lids; and group C, lower lid and lateral canthal area. Before and after the IPL treatment sessions, we obtained the lid abnormality score (LAS), meibum expressibility (ME), meibum quality (MQ), lipid layer thickness (LLT), type I Schirmer test (ST), tear break-up time (TBUT) test, corneal fluorescein staining scores (CFSs), and Ocular Surface Disease Index (OSDI). Results: IPL treatment significantly improved LASs, ME, MQ, TBUT, CFS, and OSDI values in all groups. Differences in LAS values before and after IPL treatment were significantly greater in groups B and C than those in group A. Conclusions: IPL treatment encompassing the upper lid and lateral canthus together with the lower lid elicited additional improvement in patients with MGD. The additional effect on treating the lateral canthus was similar to the effect observed on the additional treatment of the upper lid. Full article