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Meibomian gland dysfunction and keratopathy are associated with dry eye disease in aniridia
  1. Erlend Christoffer Sommer Landsend1,2,
  2. Hilde Røgeberg Pedersen3,
  3. Øygunn Aass Utheim1,
  4. Jiaxin Xiao2,4,
  5. Muhammed Yasin Adil2,4,
  6. Behzod Tashbayev5,
  7. Neil Lagali6,
  8. Darlene Ann Dartt7,
  9. Rigmor C Baraas3,
  10. Tor Paaske Utheim1,3,4,5,8
  1. 1 Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
  2. 2 Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3 National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway
  4. 4 Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
  5. 5 Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
  6. 6 Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  7. 7 Schepens Eye Research Institute/Massachusetts Eye and Ear/Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  8. 8 Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Erlend Christoffer Sommer Landsend, Department of Ophthalmology, Oslo University Hospital, Oslo 0424, Norway; elandsend{at}


Aims To investigate the aetiology and characteristics of dry eye disease (DED) in a Nordic cohort of patients with congenital aniridia.

Methods Thirty-four Norwegian and one Danish subject with congenital aniridia and 21 healthy controls were examined. All subjects underwent an extensive dry eye examination, including evaluation of meibomian glands (MGs) by meibography, measurement of tear production and tear film osmolarity and grading of vital staining of the ocular surface. Moreover, slit-lamp biomicroscopy was undertaken, including grading of aniridia-associated keratopathy (AAK).

Results Mean tear film osmolarity was significantly higher (314±11 mOsmol/L) in patients with aniridia compared with the healthy control group (303±11 mOsmol/L, p=0.002). Vital staining score was higher in the aniridia group (4.3±3.0) compared with healthy controls (2.4±1.6, p=0.02). The degree of staining correlated positively with the stage of AAK (r=0.44, p=0.008) and negatively with corneal sensitivity (r=−0.45, p=0.012). Number of expressible MGs was lower in aniridia subjects (2.9±1.6) than in controls (4.0±1.3, p=0.007). MG loss, staged from 0 to 3, was higher in the aniridia group than in the control group, both in upper eyelid (0.86±0.89 vs 0.10±0.31, p=0.001) and lower eyelid (0.94±0.73 vs 0.30±0.47, p=0.003). Computerised analyses showed thinning (p=0.004) and lower density (p<0.001) of the MGs compared with the healthy population.

Conclusions Patients with congenital aniridia demonstrate increased tear film osmolarity, ocular surface staining, loss of MGs and lower MG expressibility. We conclude that meibomian gland dysfunction and keratopathy are related to development of DED in aniridia.

  • iris
  • ocular surface
  • eye lids
  • cornea
  • tears

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  • Contributors ECSL, HRP, ØAU, RCB, TPU: Data acquisition and research execution. ECSL, HRP, ØAU, JX, MYA, BT, NL, DAD, RCB, TPU: Research design, data analysis and interpretation, manuscript preparation.

  • Funding The patient organisation Aniridia Norway, Dr Jon S Larsen’s foundation, Inger Holm’s memorial foundation, the Norwegian Association of the Blind and Partially Sighted, the Norwegian Ophthalmological Society and the Department of Ophthalmology and Department of Medical Biochemistry at Oslo University Hospital have financially supported part of this study. The funding organisations had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee approval was obtained from the Norwegian Regional Committees for Medical and Health Research Ethics (Application no. 2014/382).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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