Examination of Gland Dropout Detected on Infrared Meibography by Using Optical Coherence Tomography Meibography

doi:10.1016/j.jtos.2016.10.001

The Ocular Surface

Volume 15, Issue 1, January 2017, Pages 130-138.e1

https://doi.org/10.1016/j.jtos.2016.10.001 Get rights and content

Abstract

Purpose

To elucidate the anatomic details of gland dropout detected on two-dimensional infrared (IR) meibography in cases of dry eye associated with meibomian gland dysfunction (MGD) by using three-dimensional optical coherence tomography (OCT) meibography.

Methods

In this cross-sectional, observational case series, we enrolled gland dropout detected on IR meibography; the condition was then examined using a real-time swept-source OCT system. Accordingly, a series of 500 raster B-scan OCT images, with the gland dropout site (observed on IR imaging) at the center, were obtained and rendered as three-dimensional volume images. The OCT images were classified based on the anatomic details, including acini and ducts, at the meibomian glands (Group I, constricted acini; II, atrophic acini; III, no acini).

Results

The percentage of disagreement between IR and OCT images for dropout detected on IR imaging was 49.45% (43 and 93 cases in group I and II, respectively). Loss of the meibomian glands on both IR and OCT imaging (Group III) was observed in 50.55% cases (133 and 6 cases of gland dropout at the partial and whole eyelid on IR imaging, respectively). The proportion of disagreement between IR and OCT images (Group I and II) was higher in the middle area (63/119, 53.39%), as compared to that in the nasal (34/73, 46.58%) or temporal areas of the eyelid (26/65, 40%).

Conclusions

The loss of the meibomian glands, as observed on IR imaging, should be carefully interpreted, and OCT images may be useful to confirm the anatomic details of the meibomian glands.

Introduction

Meibomian glands are a type of sebaceous glands located in the eyelids and consist of excretory acini connected with long central ducts via short ductules.1, 2 Each acinus is composed of several meibocytes whose contents (meibum) are secreted in a holocrine manner.1, 3 These excretions play a vital role in forming the lipid component of tear films, and are essential for ensuring stability and maintenance of the ocular surface.⁴

Meibomian gland dysfunction (MGD) is caused by the hyperkeratinization of the excretory duct and orifice, or by degenerative atrophic processes as a result of aging, contact lens use, or inflammatory events.1, 4, 5, 6, 7 MGD is considered as one of the main causes of dry eye. MGD-related dry eye leads to the disturbance of tear film composition, wherein the change in the lipid phase of the tear film is greater than that in the aqueous phase.⁸

This condition can be diagnosed via indirect methods, such as tear osmolarity, tear break-up time (TBUT), and lipid layer thickness (LLT),⁹ or via direct methods such as meibography, which yields images of the meibomian glands using transillumination or infra-red (IR) light.10, 11, 12 Although indirect methods are objective in nature, they may be associated with a certain degree of interobserver or intraobserver error. In contrast, the direct method enables the observation of the detailed anatomic structure of the meibomian glands.

IR meibography is commonly used in the clinical setting as a direct method for diagnosis, and enables the two-dimensional imaging of the meibomian glands.⁴ Using this technique, the abnormal structure of the meibomian glands, such as in cases of gland dropout, can be confirmed; however, the detailed anatomic structure of the acini or ducts in the meibomian glands cannot be clearly elucidated. Furthermore, two-dimensional IR imaging does not yield depth information, and the results may vary depending on the amount of light from the external source. Ngo et al.¹³ reported that dropout scores based on the IR images for meibomian glands did not correlate with clinical signs, and suggested the need for an another method to evaluate the structural changes, including dropout.

Three-dimensional meibography imaging via swept-source/Fourier-domain optical coherence tomography (OCT) was developed to resolve the problems associated with two-dimensional images from IR meibography.¹⁴ The OCT system uses a long coherence swept laser source with a wavelength (1300 nm) close to that of IR light to enhance the OCT imaging depth range.

To our knowledge, no study has clarified the detection of dropout of the meibomian glands on IR imaging by using OCT images. In the present study, we aimed to elucidate the anatomic details of gland dropout on IR images based on the data obtained via OCT imaging.

Section snippets

Methods

Subjects: In this cross-sectional study, we examined cases of meibomian gland dropout, as observed on IR meibography, among patients who visited Seoul Saint Mary's Hospital with symptoms of dry eye between November 2014 and July 2015. The gland dropout on IR meibography in the lower eyelids was excluded because OCT meibography did not yield sufficient data to elucidate the anatomic details of this region. Moreover, the other exclusion criteria were as follows: history of any ocular surgery

Results

Based on IR meibography findings, a total of 275 cases of meibomian gland dropout were enrolled in this study. 115 eyes of 64 subjects with gland dropout exhibited the evaporated type of dry eye associated with meibomian gland dysfunction. Moreover, the Schirmer test result (8.74 ± 6.76 s), TBUT (4.34 ± 2.54 s), and corneal staining score indicated the state of instability of the tear film, whereas the lid margin abnormality score showed a condition similar to that noted in cases of MGD (Table 1

Discussion

In the present study, we aimed to elucidate the anatomic details of gland dropout by using OCT meibography in cases with a loss of meibomian glands on IR imaging. Cases with gland dropout, detected via IR imaging, were classified into 3 groups based on the detailed information of the acini or ducts of the meibomian glands obtained on OCT imaging.

The determination of the changes in the acini in the meibomian glands is important for the diagnosis and management of MGD in the clinical setting.

Conclusion

OCT images yield detailed information regarding the acini and ducts in cases with dropout of the meibomian glands, which cannot be obtained via IR imaging. The loss of the meibomian glands on IR imaging should be carefully interpreted, and OCT imaging can be considered to determine the actual loss or changes in the meibomian glands. The correlation between the structural changes in the meibomian glands and clinical parameters of the tear film, as well as the changes over time may represent a

Acknowledgments

We thank the individuals who carefully managed the data regarding dry eye examinations. The statistical analyses performed in this study were reviewed by the Department of Biostatics at The Catholic University of Korea.

References (41)

R. Arita et al.
Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population
Ophthalmology
(2008)
R. Arita et al.
Contact lens wear is associated with decrease of meibomian glands
Ophthalmology
(2009)
W.D. Mathers et al.
Meibomian gland function and giant papillary conjunctivitis
Am J Ophthalmol
(1992)
C.J. Nien et al.
Age-related changes in the meibomian gland
Exp Eye Res
(2009)
H. Pult et al.
Comparison of subjective grading and objective assessment in meibography
Cont Lens Anterior Eye
(2013)
R. Arita et al.
Increased tear fluid production as a compensatory response to meibomian gland loss: A multicenter cross-sectional study
Ophthalmology
(2015)
E. Goto et al.
Low-concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction
Ophthalmology
(2002)
R. Arita et al.
Effects of eyelid warming devices on tear film parameters in normal subjects and patients with meibomian gland dysfunction
Ocul Surf
(2015)
E. Knop et al.
The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland
Invest Ophthalmol Vis Sci
(2011)
A.J. Bron et al.
Wolff's Anatomy of the Eye and Orbit
(1997)

N. Nicolaides et al.

Meibomian gland studies: comparison of steer and human lipids

Invest Ophthalmol Vis Sci

(1981)

H. Obata

Anatomy and histopathology of human meibomian gland

Cornea

(2002)

K.K. Nichols et al.

The international workshop on meibomian gland dysfunction: executive summary

Invest Ophthalmol Vis Sci

(2011)

D. Finis et al.

Evaluation of lipid layer thickness measurement of the tear film as a diagnostic tool for Meibomian gland dysfunction

Cornea

(2013)

R. Arita et al.

Objective image analysis of the meibomian gland area

Br J Ophthalmol

(2014)

R. Arita

Validity of noninvasive meibography systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph

Cornea

(2013)

H. Pult et al.

A review of meibography

Optom Vis Sci

(2012)

W. Ngo et al.

Repeatability of grading meibomian gland dropout using two infrared systems

Optom Vis Sci

(2014)

H.S. Hwang et al.

In vivo 3D meibography of the human eyelid using real time imaging fourier-domain OCT

PLoS One

(2013)

A.J. Bron et al.

Grading of corneal and conjunctival staining in the context of other dry eye tests

Cornea

(2003)

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Imaging using OCT allows three-dimensional evaluation of the meibomian glands compared with two-dimensional evaluation using meibography or IVCM. One study found a 50% discrepancy in the assessment of meibomian gland dropout with infrared meibography compared with a images acquired using a customised OCT [366]. However, to date, no peer reviewed publications have evaluted meibomian gland characteristics amongst contact lens wearers using OCT.
Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease.
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The meibomian glands are lipid-secreting glands located in the tarsal plates, whose secretory products cover the tear film, thereby reducing evaporation as well as ensuring lubrication of the ocular surface. The meibomian glands can be visualized at different levels of magnification by infrared meibography, laser confocal microscopy, and optical coherence tomography. These imaging modalities have been subject to much research and progress in clinical practice and have shaped our current understanding of meibomian glands in health and disease. In this review, we explore the evolution of meibography over the past decades, the major contributions of various meibographic modalities, and discuss their clinical significance.
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They also found a higher percentage of disagreement in the middle portion of the upper eyelid, probably because of the more uniform palpebral thickness in the middle area compared to the nasal or lateral ones. With OCT imaging Yoo et al. [30] obtained more detailed information about the anatomical structure of meibomian glands previously evaluated solely with meibography whose results have to be carefully interpreted. It was also stated that in the future a more appropriate treatment may be adopted based on OCT anatomic features like the status of the acini: their absence would require lipid-containing eye drops or ointment, while their progressive loss on obstructive MGD would require meibum secretion improving therapies.
Meibomian gland dysfunction (MGD) can be considered the leading cause of dry eye disease (DED) and one of the most common ophthalmic disorders found in clinical practice. The growing body of literature provides a substantial amount of information on this condition, but more efforts are needed to better interpret research data and to properly apply them to daily clinical practice., In this article, we reviewed the most recent publications on MGD diagnosis and management, focusing on the highest available level of evidence, provided by well-designed and well-reported studies on humans., Latest evidences on MGD diagnosis are mainly focused on imaging techniques, including meibography, optical coherence tomography (OCT), and in vivo confocal microscopy. Meibographic parameters, such as drop-out and glands’ distortion, show great diagnostic accuracy, which accounts for their widespread use in clinical practice and research., Recent randomized controlled clinical trials on MGD treatment provided data on the role of antibiotics, steroids, essential fatty acids, intraductal meibomian gland probing, electronic heating devices and intense pulsed light therapy.
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Les dysfonctionnements des glandes de Meibomius (DGM) regroupent un ensemble de pathologies complexes de la surface oculaire. Ils représentent une des principales étiologies de sécheresse oculaire mais aussi une des premières causes de consultation en ophtalmologie. Les tests cliniques classiques (symptômes de sécheresse oculaire, temps de rupture du film lacrymal, évaluation de l’expressibilité glandulaire ou test de Schirmer) ne permettent qu’une évaluation indirecte de la fonction meibomienne et des glandes de Meibomius. Diverses méthodes d’investigation in vivo ont donc été développées pour imager les glandes de Meibomius telles que la meibographie, la tomographie en cohérence optique, l’échographie ou encore la microscopie confocale in vivo. Certaines sont accessibles en pratique clinique, tandis que d’autres restent dans le domaine de la recherche clinique. Tous ces techniques ont pour objectif de développer une analyse structurelle directe des glandes de Meibomius afin d’aider au diagnostic des DGM mais aussi de mieux comprendre la physiopathologie des glandes de Meibomius. Cette revue de la littérature a pour objectif de donner un aperçu des modalités d’imagerie existante et de leur intérêt dans l’évaluation des glandes de Meibomius et des DGM.
Meibomian gland dysfunction (MGD) encompasses a group of complex pathologies of the ocular surface. They represent one of the main etiologies of dry eye but also one of the leading causes of consultation in ophthalmology. Conventional clinical tests (dry eye symptoms, tear film rupture time, glandular expressiveness assessment, or Schirmer's test) allow only an indirect assessment of Meibomian gland function and physiology. Various in vivo investigation methods have therefore been developed to image the meibomian glands such as meibography, optical coherence tomography, ultrasound or in vivo confocal microscopy. Some are accessible in clinical practice, while others remain in the field of clinical research. All these techniques aim to develop a direct structural analysis of the Meibomian glands to help in the diagnosis of DGM but also to better understand the pathophysiology of Meibomian glands. This review of the literature aims to provide an overview of existing imaging modalities and their interest in the evaluation of Meibomian glands and MGD.
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Citation Excerpt :
This change in MG volume might correspond to atrophic degeneration of the acinar tissue of the MG's described in ex vivo histologic studies or a MG loss observable on meibography. A satisfactory correlation has been shown between MG evaluation based on infrared-coupled OCT and contact meibography with lid transillumination [51,52]. The analytic performance of meibography compared to OCT with three-dimensional reconstruction has been evaluated in a population of dry eye patients.
Meibomian gland dysfunction (MGD) includes a group of complex disorders of the ocular surface. It represents one of the main etiologies of dry eye as well as one of the main reasons for patient visits to the ophthalmologist. Classic clinical tests (dry eye symptoms, tear film break-up time, evaluation of gland expressibility or Schirmer's testing) only provide an indirect assessment of the function of the Meibomian glands and the meibum. Various in vivo testing methods have therefore been developed to image the Meibomian glands, such as Meibography, optical coherence tomography, ultrasound, or even in vivo confocal microscopy. Some are accessible in clinical practice, while others are limited to the realm of clinical research. All of these techniques aim to develop a direct structural analysis of the Meibomian glands so as to assist in the diagnosis of MGD as well as to better understand the pathophysiology of the Meibomian glands. This review of the literature hopes to provide an overview of the current imaging modalities and their role in the evaluation of the Meibomian glands and MGD.

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: The authors have no commercial or proprietary interest in any concept or product described in this article.

: Single-copy reprint requests to Choun-Ki Joo, MD, PhD (address below).

: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

: This article contains additional online-only material. The following should appear online-only: Supplemental Table, Video 1, and Video 2.

^∗: Choun-Ki Joo and Tae Joong Eom contributed equally to this work.

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Original ResearchExamination of Gland Dropout Detected on Infrared Meibography by Using Optical Coherence Tomography Meibography

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Acknowledgments

Ophthalmology

Ophthalmology

Am J Ophthalmol

Exp Eye Res

Cont Lens Anterior Eye

Ophthalmology

Ophthalmology

Ocul Surf

The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland

Invest Ophthalmol Vis Sci

Wolff's Anatomy of the Eye and Orbit

Meibomian gland studies: comparison of steer and human lipids

Invest Ophthalmol Vis Sci

Anatomy and histopathology of human meibomian gland

Cornea

The international workshop on meibomian gland dysfunction: executive summary

Invest Ophthalmol Vis Sci

Evaluation of lipid layer thickness measurement of the tear film as a diagnostic tool for Meibomian gland dysfunction

Cornea

Objective image analysis of the meibomian gland area

Br J Ophthalmol

Validity of noninvasive meibography systems: noncontact meibography equipped with a slit-lamp and a mobile pen-shaped meibograph

Cornea

A review of meibography

Optom Vis Sci

Repeatability of grading meibomian gland dropout using two infrared systems

Optom Vis Sci

In vivo 3D meibography of the human eyelid using real time imaging fourier-domain OCT

PLoS One

Grading of corneal and conjunctival staining in the context of other dry eye tests

Cornea

Original Research
Examination of Gland Dropout Detected on Infrared Meibography by Using Optical Coherence Tomography Meibography