Résumé
Background Meibomain gland is a specially differentiated sebaceous gland lying in the tarsus of upper and lower eyelid.The morphological changes of the gland is associated with a variety of ocular surface diseases.Studying the relationship of morphological and functional change of meibomain gland with ocular surface is of great significance.Objective This study was to observe the change of morphology,structure and function of meibomain gland over aging and investigate the assocation of meibomain gland abnormality with ocular surface.Methods A prospectively cases-observational study was performed.Ninety-three eyes of 93 patients with age-related cataract aged 45 and older were enrolled in Shanxi Eye Hospital from March to September 2016 under the informed consent.The patients were divided into 45 to 59-year group and ≥60-year group according to age or meibomian gland loss ≥ 1/3 group and meibomian gland loss ＜ 1/3 group.The ocular anterior segment,lid margin,meibomian gland orifices and lipids traits were examined by slit-lamp microscope.The ocular surface symptoms were assessed and scored by Ocular Surface Disease Index (OSDI) scale.The break-up time of tear film (BUT),tear meniscus height,meibomian gland dropout degree,conjunctival hyperemia and corneal fluorescence staining scores were measured using ocular surface analyzer.Results No dry eye symptom was complained in all the subjects,and their OSDI scores were ＜12.No abnormal changes at the lid margin and the muco-cutaneous junction were observed.No abnormality of the meibomian gland orifices,the lipids traits and drainage was observed under the slit-lamp microscope.BUT was shortened in 42 eyes (45.16％);tear meniscus height was lowed in 52 eyes (55.91％);meibomian gland loss range was ≥1/3 in 58 eyes (62.27％).The meibomian gland loss scores were 1.65±0.79 in the 45 to 59-year group and 1.86±0.72 in the ≥60-year group,showing an insignificant difference between them (t =1.301,P =0.197).But when coming to the correlation analysis,a positive correlation was found between meibomian gland loss scores and age (rs =0.323,P=0.002),and no correlations were seen between age and BUT or tear meniscus height (rs =0.154,P =0.141;rs=-0.024,P =0.821).In addition,meibomian gland loss scores showed a negative correlation with mean BUT (rs =-0.251,P =0.015).The eye number of BUT abnormality in the meibomian gland loss ≥ 1/3 group was more than that in meibomian gland loss ＜1/3 group (P =0.018).Conclusions Meibomian gland loss is more serious over aging in middle aged and elderly population,and serious meibomian gland loss increases the risk of tear film instability.The early meibomain gland dysfunction-like signs occur prior to symptoms,which should raise concern in clinical work.
Résumé
Background The incidence of dry eye is increasing among young adults because of wide usage of video display terminal.But the early diagnosis of dry eye still presents challenge to medical practitioners.The accurate diagnosis and treatment of the dry eye,therefore,is a topic of high interest to researchers.Previous examination outcome of dry eye is interferred primarily due to invasive procedure.It is very important to search an examination approach.Objective This study was to use Keratograph 5M,a non-invasive ocular surface analyzer to evaluate the influence of watching video display terminal on ocular surface and tear film.Methods Eighty-one eyes of 81 health volunteers among 18-30 years were enrolled in Affiliated Eye Hospital of Nanchang University from March 1,2015 to November 10,2015 under the informed consent,including 39 males and 42 females.The subjects watched the computer for continuously 3 hours under the nature light,and ocular surface related examinations were performed and compared before and after video display terminal exposure,including non-invasive tear film break-up time (NITBUT),tear meniscus height,conjunctival hyperemia scoring,limbal congestion scoring,corneal fluorescein staining scoring,meibomian gland imaging and lipid layer analysis.Results The number of eyes with visual fatigue,dryness,pain,blurring and conjunctival congestion was significantly increased after 3-hour video display terminal exposure in comparison with before (all at P＜0.01).The initial NITBUT and mean NITBUT were (6.086± 3.701) s and (9.103 ± 4.680) s,and tear meniscus height was (0.190 ± 0.032) mm after trail,which were significantly lower than (11.445 ±4.964) s,(14.626 ±4.467) s and (0.212 ±0.040) mm of before trail,respectively;The conjunctical hyperemia scoring and limbal congestion scoring were 0.869 ±0.311 and 0.572 ±0.276 after trial,which were significantly higher than 0.780 ± 0.306 and 0.509 ± 0.266 before trail,showing significant differences before and after exposure of video display terminal (all at P＜0.01).The intraocular pressure and the eye number of different scores of corneal fluorescence staining,abnormal meibomian gland and different morphological lipid layer of tear were unchanged before and after exposure of video display terminal.Conclusions Long-term exposure of video display terminal results in significant and temporary adverse influence on tear film and ocular surface.Keratograph 5M non-invasive ocular sudace analyzer can objectively assess overall ocular surface conditions.