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In vivo confocal microscopy of meibomian glands in glaucoma
  1. Luca Agnifili1,
  2. Vincenzo Fasanella1,
  3. Ciro Costagliola2,
  4. Cristina Ciabattoni1,
  5. Rodolfo Mastropasqua3,
  6. Paolo Frezzotti4,
  7. Leonardo Mastropasqua1
  1. 1Department of Medicine and Aging Science, Ophthalmic Clinic. University G d'Annunzio of Chieti-Pescara, Chieti, Italy
  2. 2Department of Health Science, University of Molise, Campobasso, Italy
  3. 3Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
  4. 4Department of Ophthalmology, University of Siena, Siena, Italy
  1. Correspondence to Dr Luca Agnifili, Department of Medicine and Aging Science, Ophthalmic Clinic. University G d'Annunzio of Chieti-Pescara, Via dei Frentani, 114, Chieti 66100, Italy; l.agnifili{at}


Aim To investigate, using laser scanning confocal microscopy (LSCM), the morphological changes of meibomian glands (MGs) in patients with glaucoma.

Methods A total of 80 patients who were glaucomatous were enrolled, and 20 healthy subjects were used as controls. After completing an Ocular Surface Disease Index (OSDI) questionnaire, all subjects underwent tear film break-up time (BUT), fluorescein staining, Schirmer test I (STI) and LSCM examination of the MGs. The main outcome measures were: eyelid margin epithelial cell density, mean acinar density (MAD) and area (MAA), glandular orifice area, secretion reflectivity and inhomogeneous appearance of interstice and acinar wall.

Results According to the number of anti-glaucoma medications they were taking, patients were divided into three groups: group 1 (30 eyes), one drug; group 2 (23 eyes), two drugs; group 3 (27 eyes), three or more drugs. LSCM showed lower MAD and MAA, greater secretion reflectivity and glandular orifice area in groups 2 and 3 than in controls (p<0.05). The inhomogeneity of the interstice and acinar wall was significantly greater in all groups compared to controls (p<0.05). Preserved prostaglandin analogues (PGAs) induced more pronounced modifications of all parameters than preservative free (PF)-PGAs (p<0.05). No significant differences were found between preserved and PF-β-blockers. Significant relations were found among MAD, MAA, secretion reflectivity and OSDI score, BUT and ST (p<0.05) and between secretion reflectivity and orifice area (p<0.001).

Conclusions In vivo LSCM is an effective tool in revealing morphological changes of MGs induced by anti-glaucoma medications. Given the key role in the ocular surface health, the evaluation of MG status in patients who are glaucomatous is worthwhile.

  • Conjunctiva
  • Eye Lids
  • Glaucoma
  • Imaging
  • Treatment Medical
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