Impact of Systemic EGFR Inhibitors on Meibomian Glands: A Meibographic Analysis With Clinical Correlations

Epidermal growth factor receptor (EGFR) signaling promotes meibomian gland (MG) epithelial and mesenchymal cell proliferation and is involved in MG morphogenesis. This study aimed to evaluate the impact of systemic EGFR inhibitor (EGFR-I) therapy on MG status using meibography, and its association with ocular surface clinical parameters.

In this prospective study, 39 patients with no prior history of ocular surface disease who were scheduled to receive systemic EGFR-I therapy for various malignancies were enrolled. All participants underwent Schirmer test, tear film break-up time, ocular surface disease index questionnaire, noninvasive tear break-up time, and noncontact meibography using Sirius topography at baseline, and at 1 and 3 months after treatment initiation. MG loss was quantified and staged based on meibographic analysis.

Of the 39 participants, 28 (72%) were female and 11 (28%) were male, with a mean age of 61.8 ± 11 years. Baseline Schirmer test and tear film break-up time values (15.6 ± 4.2 mm and 13.2 ± 3.5 seconds) showed a significant reduction at 1 month (13.8 ± 3.8 mm; 11.1 ± 3.0 seconds), with a further decline observed at 3 months (8.1 ± 3.1 mm; 7.4 ± 2.7 seconds) (P < 0.001). The mean ocular surface disease index score increased from 7.7 ± 6.9 at baseline to 11.6 ± 7.3 at 1 month and 30.3 ± 14.6 at 3 months (P < 0.001). Noninvasive tear break-up time values decreased significantly at 3 months (5.9 ± 2.6 seconds) relative to baseline (11.1 ± 4.5 seconds) (P < 0.001). Meibographic assessments revealed a progressive increase in MG loss percentage and staging from baseline (14.7 ± 6.2%; stage 0.8 ± 0.5) to 1 month (21.3 ± 6.5%; stage 1.3 ± 0.4) and 3 months (31.6 ± 11%; stage 1.9 ± 0.6) (P < 0.001).

Systemic EGFR-I therapy may contribute to progressive MG loss, which may be associated with ocular side effects commonly observed in patients receiving these agents, including dry eye disease, blepharitis, and meibomitis. Early recognition and management of these complications by ophthalmologists may improve patient comfort and support adherence to oncologic treatment.