Proposed diagnostic criteria for seborrheic meibomian gland dysfunction

To compare clinical findings between patients with seborrheic meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for seborrheic MGD.

Thirty eyes of 30 patients [13 men and 17 women; age (mean +/- SD) 73.9 +/- 9.9 years] diagnosed with seborrheic MGD and 60 eyes of 60 healthy volunteers (22 men and 38 women; age: 71.0 +/- 9.3 years) as a control group were included in this study. Ocular symptoms were scored from 0 to 14 according to the number of symptoms present. Lid margin abnormality was scored from 0 to 4 depending on the number of abnormalities present. Meibomian gland changes were scored from 0 to 6 on the basis of noncontact meibography (meiboscore). Superficial punctate keratopathy was scored from 0 to 3. Tear film production was evaluated by Schirmer test. Receiver operating characteristic curves with calculations of the area under the curve were used to describe the accuracy of each parameter to differentiate patients with seborrheic MGD from normal eyes.

Ocular symptom score and lid margin abnormality score were significantly higher in the seborrheic MGD group than in the control group (P < 0.0001 for both scores). Area under the curve values indicated that the lid margin abnormality score had the highest diagnostic power as a single parameter followed by the ocular symptom score. When the diagnosis for seborrheic MGD was made on the basis of the 2 scores (ocular symptom score and lid margin abnormality score) being abnormal, the sensitivity was 100% and the specificity was 98.3%.

On the basis of these findings, we recommend that physicians use ocular symptom score and lid margin abnormality score in the diagnosis of seborrheic MGD. Seborrheic MGD should be considered very likely when both of the 2 scores are abnormal.