RÉSUMÉ
ABSTRACT Langerhans cell histiocytosis comprises a heterogeneous range of clinical manifestations secondary to clonal proliferation of histiocytes, characterized by the accumulation of these cells in various organs and tissues. The ophthalmological component commonly involved is the orbit. Herein, we report a rare case of Langerhans cell histiocytosis with eyelid involvement, which resulted in severe ocular surface complications, which subsequently significantly impacted the patient's quality of life. This case report highlights the fact that despite being rare, Langerhans cell histiocytosis should be included in the differential diagnosis of eyelid lesions. Furthermore, a multidisciplinary approach with a systemic overview is crucial for managing the ocular complications.
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.