January 3, 2022
By Trang Truong, BOptom, and Yen Tran, MD, PhD
Meibum from the meibomian glands is essential to tear film stability and ocular surface health. Any abnormalities of duct obstruction and/or glandular secretion are referred to as meibomian gland dysfunction (MGD) and can result in evaporative dry eye. Chronic MGD may result in meibomian gland atrophy. Meibomian gland atrophy, therefore, has been a valuable parameter in diagnosing MGD and assessing dry eye disease (DED). Although the prevalence of meibomian gland loss in the adult population is widely studied, data from the pediatric population remain limited. This cross-sectional study aimed to report the prevalence of meibomian gland atrophy and gland tortuosity in children.
The study included 99 participants aged 4 to 17 years with no previous history of DED or objective findings of MGD. Additionally, patients were excluded from evaluation if they had any current systemic conditions or medications that may induce gland morphological alteration or eyelid pathologies such as chalazion and blepharitis. Meibography of the lower eyelid was taken by the LipiView II for dynamic meibomian gland imaging, and the grading systems were applied for meibomian gland atrophy and tortuosity. The validated 5-point meiboscale for gland atrophy (grade 0 to 4) and the 3-point scale for tortuosity (grade 0 to 2) show that the increasing score follows the severity.
Only images of one eye were analyzed. The mean meiboscore for gland atrophy and tortuosity was 0.58 ± 0.80 and 0.45 ± 0.64, respectively. Grades more than 0 accounted for 42% of gland atrophy and 37% for gland tortuosity. Although there was no significant association between age, sex, or race and the manifestations of meibomian gland atrophy, boys appeared to have a significantly higher prevalence of gland tortuosity than girls.
The study provided baseline normative data of meibomian gland architecture from a U.S. pediatric population for the first time. The majority of mild gland atrophy appearing in the asymptomatic population suggested that meibomian gland atrophy may be a normal morphology in children. The study findings also support the examination of gland atrophy in young patients for early detection of DED and MGD. However, longitudinal studies are necessary to better understand the temporal variation in meibomian gland morphology. Since participants from only one eye care center were enrolled, there is a selection bias, and caution needs to be exercised while extrapolating the data to a general pediatric population.
Prevalence of Meibomian Gland Atrophy in a Pediatric Population
Preeya K. Gupta, Madelyn N. Stevens, Namita Kashyap, Yos Priestley
Purpose: To report the prevalence of meibomian gland atrophy and gland tortuosity in a pediatric population.
Methods: Participants who presented with no history of dry eye disease or meibomian gland dysfunction were recruited from the Duke University Eye Center. Meibography was performed and subjective symptoms were assessed through the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Grading of images was assessed by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and a 3-point scale for gland tortuosity (0-2).
Results: Ninety-nine eyes of 99 participants (50 females) aged 4 to 17 years (mean 9.6 years) were imaged. The mean meiboscore was 0.58 ± 0.80 (mean ± SD) for gland atrophy and 0.45 ± 0.64 for tortuosity. In all subjects, 42% (n = 42) had any evidence of meibomian gland atrophy (meiboscore >0) and 37% (n = 37) had any evidence of meibomian gland tortuosity. The majority of subjects had mild gland atrophy. No significant association was found between age, sex, or race and presence of gland atrophy. Males were significantly more likely to have gland tortuosity (P = 0.0124, odds ratio 3.36).
Conclusions: This study reveals a relatively high level of mild meibomian gland atrophy in the pediatric population, though moderate-severe gland atrophy was also present in this young population. This calls into question our current understanding of baseline gland architecture and suggests that perhaps clinicians should be examining young patients for meibomian gland atrophy and dysfunction because it may have implications for future development of dry eye disease.
Gupta, P. K., Stevens, M. N., Kashyap, N., & Priestley, Y. (2018). Prevalence of meibomian gland atrophy in a pediatric population. Cornea, 37(4), 426.
|Trang Truong, BOptom, is an optometrist at the Myopia Control Clinic of Hai Yen Eye Care, Ho Chi Minh City, Vietnam, and is working on myopia-related projects in collaboration with BHVI.
|Yen H. Tran, MD, PhD, Assoc. Prof., is the President of Hai Yen Vision Institute in Ho Chi Minh City, Vietnam, a leading translational research center in the field of myopia and refractive surgery in Vietnam. She has been collaborating with BHVI and other international entities over the years.