Meibomian Gland Loss and Dysfunction in Mild versus Moderate-Severe Thyroid Eye Disease

To compare meibomian gland (MG) loss and MG dysfunction (MGD) in patients with mild versus moderate-severe thyroid eye disease (TED).

Consecutive patients with TED and no other causes of dry eye disease underwent meibography and meiboscore of each eyelid were 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, noninvasive tear break-up time (NITBUT), and tear meniscus height (TMH) were also assessed by a masked observer.

Included were 21 eyes (21 patients) with mild and 19 eyes (19 patients) with moderate-severe TED. The 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). Total meiboscore had a significantly positive correlation with OSDI (r_s = 0.37) and tear film osmolality (r_s = 0.50) as well as a 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.

MG loss and MGD were significantly more severe in moderate-severe than mild TED.