Original article
Marx Line: Fluorescein Staining Line on the Inner Lid as Indicator of Meibomian Gland Function

https://doi.org/10.1016/j.ajo.2005.11.004Get rights and content

Purpose

To determine whether the location of a fluorescein-stained line, the Marx line (ML), which runs along the inner eyelid, is correlated with meibomian gland function.

Design

Prospective observational case series.

Methods

After applying fluorescein dye solution to the eye, the ML score was calculated for the outer, middle, and inner thirds of the lower eyelid margin. ML scoring was as follows: 0, entirely on the conjunctival side of the meibomian orifices (MOs); 1, part of the ML touches the MOs; 2, ML runs through all of the MOs; and 3, ML runs on the eyelid-margin side of the MOs. Correlations were calculated between the total ML score and age for 251 randomly recruited subjects without acute ocular surface diseases, and between age and the ML score for the three regions of the lower eyelid. Correlations between the regional ML score and the meibographic score, and the meibomian gland secretion score were also determined. The total ML scores of 15 subjects without meibomian gland dysfunction (MGD) were compared with 15 age-matched patients with MGD.

Results

The three regions of the lower eyelid had significantly different ML scores. Strong correlations were found between the ML score and age, the meibographic score, and the meibomian gland secretion score. The total ML score of MGD group was significantly higher than that of the non-MGD group.

Conclusions

The strong correlation between the ML score and the meibomian gland scores indicates that the ML score can be used as a simple and rapid screening score for meibomian gland function.

Section snippets

Methods

The purpose of this study and the procedures to be used were presented to all of the subjects and patients, and signed informed consent was obtained from each individual. The procedures used in this study conformed to the tenets of the Declaration of Helsinki.

A total of 251 subjects (105 men and 146 women, ages 59.8 ± 20.3 years [mean ± SD]) were randomly recruited from the patients who were treated at the Department of Ophthalmology of Ehime University Hospital, Ehime, Japan. None of these

Results

Among five ophthalmologists, inconsistency of a score was settled in less than one for the ML score, and scores did not differ by two or more for all 20 images. There was 100% coincidence in 8 (40%) of 20 images, 80% coincidence in 10 (50%) of 20 images, and 60% coincidence in all 20 images.

The staining pattern of the eyelid margin with fluorescein is shown in Figure 4. A sharply defined line can be seen on the inner eyelid, and the staining with rose bengal and lissamine green B solutions was

Discussion

The concept of an evaporative type of dry eye12 has become widely recognized as a result of better understanding of the pathogenesis of MGD in recent years. The importance of assessing meibomian gland function has been emphasized because lipids secreted by these glands combine with outer layers of the tear film not only to suppress evaporation of tear fluid, but also to form a hydrophobic barrier at the lid margin to prevent loss of tears.1, 2 Focusing on the latter role, we assume that the ML

Masahiko Yamaguchi, MD, graduated from the Osaka City University School (OCU) of Medicine in 1990, and served as an ophthalmologist at the OCU Hospital from 1990 to 1995. In 1996, he joined the faculty of Ehime University School of Medicine, Department of Ophthalmology, for research on ocular surface diseases. His main area of research is in dry eye.

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Masahiko Yamaguchi, MD, graduated from the Osaka City University School (OCU) of Medicine in 1990, and served as an ophthalmologist at the OCU Hospital from 1990 to 1995. In 1996, he joined the faculty of Ehime University School of Medicine, Department of Ophthalmology, for research on ocular surface diseases. His main area of research is in dry eye.

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