Elsevier

The Ocular Surface

Volume 2, Issue 2, April 2004, Pages 149-164
The Ocular Surface

The Contribution of Meibomian Disease to Dry Eye

https://doi.org/10.1016/S1542-0124(12)70150-7Get rights and content

Abstract

The tear film lipid layer is the major barrier to evaporation from the ocular surface. A decrease in its thickness or functional integrity may cause evaporative dry eye (EDE). Obstructive meibomian gland dysfunction (MGD) is the most common cause of EDE and occurs as a primary disorder or secondary to acne rosacea, seborrheic or atopic dermatitis, and with cicatrizing conjunctival disorders, such as trachoma, erythema multiforme, and cicatricial pemphigoid. MGD may be an incidental finding in asymptomatic eyes, or it may be responsible for irritative lid symptoms in the absence of dry eye. MGDdependent EDE is diagnosed on the basis of a defined degree of MGD in a symptomatic patient showing typical ocular surface damage in the absence of an aqueous tear deficiency. When MGD occurs in a background of aqueous tear deficiency (ATD), then an additional evaporative component may assumed, depending on the extent of meibomian obstruction. However, definitive criteria are not yet established. The clinical severity of dry eye is greatest when ATD and EDE occur together, particularly in Sjogren syndrome. A hypothesis is proposed to explain the steps leading to primary, simple MGD and subsequent EDE.

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    The authors have no proprietary interest in any product or concept discussed in this article. A.J. Bron is a member of the Advisory Board of Ocusense, Inc., USA.

    Single copy reprint requests to: A. J. Bron

    Abbreviations are printed in boldface where they first appear with their definitions.

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