Characterization of meibomian gland dysfunction in patients with rosacea

Ninety-three participants took part in this cross-sectional, observational, non-interventional study. These consisted of a rosacea group (n=40) and a control group (n=53). We compared objective parameters of the ocular surface, including conjunctival hyperemia, tear film stability and volume, meibomian gland dysfunction, dry eye disease, and ocular surface staining, between the two groups.

Results:

In the rosacea group, 69.23% were female. The mean age was 47.34 ± 12.62 years old. No statistically significant differences between groups were found in visual acuity (p=0.987), tear film parameters (tear meniscus height (p=0.338), noninvasive tear film rupture time (p=0.228), invasive rupture time (p=0.471), Schirmer’s test scores (p=0.244), conjunctival hyperemia (p=0.106), and fluorescein staining (p=0.489). Significant differences were found in meibography evaluations (p=0.026), mucous layer integrity (p=0.015), and ocular surface symptoms (p<0.0001). Rosacea patients also showed important eyelid differences in glandular expressibility (p<0.001), glandular secretion pattern (p<0.001), and telangiectasia (p<0.001) compared to controls.

Conclusion:

Meibomian gland dysfunction is frequently associated with dermatological conditions. It can be observed in morphological findings from meibography as well as lipid secretion impairment, leading to evaporative dry eye, ocular surface dysfunction, and inflammation.

Keywords:
Rosacea/complications; Meibomian gland dysfunction; Conjunctiva; Dry eye syndromes; Diagnostic techniques; ophthalmological

Dry eye classification	Criteria
Dry eye disease	OSDI score ≥13 AND Noninvasive tear film breakup time <10 s, corneal staining >5 spots, conjunctival staining >3 (10-15)
Aqueous tear deficiency	Diagnosis of dry eye disease AND Tear meniscus height £0.2 mm
Meibomian gland dysfunction	Diagnosis of dry eye disease AND Meibography grade ≥ 1
Mixed dry eye	Dry eye disease in the presence of aqueous tear deficiency and meibomian gland dysfunction

Variable	N=40	Frequency (%)
Age (Mean ± SD)	47 ± 12
Sex (M/F)	12/28	30%/ 70%
Fitzpatrick scale
1 and 2	25	62.5%
3 and over	15	37.5%
Rosacea subtype^* * Patients could present with more than one subtype of rosacea.
Erythematotelangiectatic	25
Papulopustular	18
Other (phymatous, ocular, mixed)	08
DLQI
0 to 5 (no or small effect)	25	62.5%
6 to 10 (moderate effect)	10	25%
>10 (large effect)	5	12.5%
Global assessment
Absent/mild	23	57.5%
Moderate/severe	17	42.5%
Treatment
No treatment	6	15%
Topical	16	40%
Systemic	14	35%
Other	4	10%

Parameter	Control	Rosacea	P-value
Parameter	Mean ± SD (Median)	Mean ± SD (Median)	P-value
OSDI	6.01 ± 9.40 (2.10)	26.30 ± 22.10 (20.83)	*<0.0001^ * p<0.05 (Mann-Whitney U-test).**
Tear meniscus (mm)	0.24 ± 0.06 (0.23)	0.22 ± 0.07 (0.22)	0.3382
NITBUT (seconds)	8.83 ± 5.26 (7.26)	7.81 ± 5.40 (5.93)	0.2282
Conjunctival redness (grade 0-4)	1.23 ± 0.64 (1.20)	1.46 ± 0.61 (1.30)	0.1064
Meibography	0-17.30% (9)	0-11.76% (4)
	1-67.30% (35)	1-52.94% (18)
	2-15.38% (8)	2-26.47% (9)
	3-0% (0)	3-11.76% (4)	0.0258 ^* * p<0.05 (Mann-Whitney U-test).
Fluorescein staining (grade 0-15)	0.47 ± 0.64 (0.00)	0.74 ± 1.07 (0.00)	0.4887
Invasive TBUT (seconds)	8.02 ± 4.48 (7.00)	6.97 ± 2.85 (7.00)	0.4709
Lissamine staining (grade 0-9)	0.90 ± 1.27 (0.00)	1.51 ± 1.43 (1.00)	*0.0152^ * p<0.05 (Mann-Whitney U-test).**
Schirmer’s test (mm)	15.61 ± 11.35 (15.00)	14.03 ± 13.46 (9.50)	0.2438

Parameters	Erythematous	Papulopustular	p-value
Symptoms
OSDI	39.76 ± 24.55 (31.25)	18.52 ± 15.77 (20.83)	0.0370^* * p<0.05 (Mann-Whitney U-test);
Tear volume
Tear meniscus height	0.22 ± 0.06 (0.21)	0.23 ± 0.09 (0.23)	0.7252
Schirmer’s test	11.62 ± 13.68 (6.50)	15.77 ± 12.01 (12.0)	0.2104
Tear stability
NITBUT	7.82 ± 5.18 (6.69)	9.03 ± 6.76 (5.90)	0.7923
Invasive TBUT	7.31 ± 3.18 (7.0)	6.77 ± 2.59 (7.0)	0.5959
Inflammation
Conjunctival redness	1.36 ± 0.49 (1.30)	1.38 ± 0.41 (1.40)	0.8603
Ocular surface damage
Fluorescein staining	0.81 ± 1.27 (0)	0.54 ± 0.78 (0)	0.8006
Lissamine staining	1.87 ± 1.82 (1.0)	1.31 ± 1.18 (1)	0.5858
Meibomian gland dysfunction
Meibography	0-11.76% (2)	0-15.38% (2)	0.2145
	1-47.05% (8)	1-46.15% (6)
	2-23.52% (4)	2-30.76% (4)
	3-17.64% (3)	3-7.69% (1)
Normal secretion			p=1.000
Yes	0	0
No	100%	100%
Obstructed glands			p=0.227
Yes	57.14%	27.27%
No	42.86%	72.73%
Granular secretion			p=0.697
Yes	35.71%	45.45%
No	64.29%	54.55%
Pasty secretion
Yes	14.29%	54.55%	p=0.043 ^ø ø p<0.05 (Fisher’s exact test).
No	85.71%	45.45%
Telangiectasias			p=0.209
Yes	85.71%	63.64%
No	14.29%	36.36%

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E-mail: abo@cbo.com.br

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[1] Corresponding author: Eduardo Buzolin Barbosa. E-mail: ebbarbosa@me.com