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Article Date: 7/1/2012

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Does Meibomian Gland Loss Cause Dry Eye Symptoms?

By Patrick J. Caroline, FAAO, & Mark P. André, FAAO

It is logical to assume that there is a relationship between meibomian gland loss and symptoms of dry eye. We recently used an infrared photography technique and a dry eye questionnaire to test this hypothesis in non-contact lens subjects and in contact lens-wearing subjects.


We examined upper and lower lid meibomian glands (Figure 1) of 200 eyes of 100 subjects (68 female and 32 male) who had a mean age of 24.6 ± 4.3 years for females and 26.1 ± 4.5 years for males. There were 73 contact lens wearers in our study group who had a mean age of 25.2 ± 4.4 years and who had been wearing contact lenses for 9.8 ± 5.8 years. We assessed the meibomian glands using a photo slit lamp equipped with an infrared video camera (Allied Vision Technology) and an infrared transmitting filter (IR-83, Hoya). The meibomian glands were then graded using a technique described by Nichols et al (2005) (Figure 2). Dry eye status was assessed using the validated Texas Eye Institute Dry Eye Questionnaire (Narayanan et al, 2005).

Figure 1. Normal upper and lower lid meibomian glands.

Figure 2. Meibomian gland grading system.


100 Normal Eyes Using Pearson correlation analysis, we were unable to establish any correlation between the dry eye questionnaire score and increased meibomian gland dropout.

73 Soft Contact Lens Wearers We were unable to establish any correlation between contact lens wear and increased meibomian gland dropout, although there was a trend for the contact lenswearing group to have more partial glands.

Gender/Birth Control Pill Use Using mixed model ANOVA analysis, we found a significant gender difference for meibomian gland grades, with females showing more meibomian gland dropout. There were 29 female subjects currently taking birth control pills (BCPs) and 39 female participants who were not. The women on BCPs had more meibomian gland dropout compared to the women not on BCPs (Figure 3). There was no significant difference in meibomian gland grades between the male subjects and the non-BCP-use female subjects. CLS

Figure 3A. A 24-year-old female with no history of birth control pill use. 3B. A 24-year-old female with a six-year history of birth control pill use.

The authors wish to thank Satomi Torii and Dr. Matt Lampa for their work with this study.

For references, please visit and click on document #200.

Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.

Contact Lens Spectrum, Volume: 27 , Issue: July 2012, page(s): 56

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