Histopathology of meibomian gland dysfunction.

We conducted a histopathologic study of he meibomian glands of seven patients (all men, ranging in age from 58 to 83 years) who had severe or moderately severe meibomian dysfunction and who were undergoing ectropion or entropion repair. Abnormal features included signs of obstruction and dilatation of ducts, enlargement of acini with cystic degeneration and squamous metaplasia, foreign-body reaction and granuloma formation, a mild increase in inflammatory cells, and abnormal keratinization. Demodex organisms were found in both acini and ducts of one patient. These findings were similar to those reported in other entities involving meibomian duct obstruction, probably related to abnormalities of keratinization, plays an important role in the pathogenesis of meibomian gland dysfunction.

Primary herpes simplex subepithelial dendritic keratitis.

A 37-year-old man developed an acute follicular conjunctivitis with preauricular lymphadenopathy believed to be epidemic keratoconjunctivitis. On the eighth day of his disease, subepithelial dendritic opacities developed in the cornea which were not typical of either epidemic keratoconjunctivitis or herpetic keratitis. A diagnosis of primary herpes simplex virus infection was established by positive viral culture and a rise in serum antibody titer to herpes simplex virus. Subepithelial dendritic keratitis as a manifestation of herpes simplex infection of the cornea has not been previously described. The lesions seen in this patient were not reproducible in rabbits and we believe they represent an unusual host response to the virus. This form of herpetic keratoconjunctivitis is extremely difficult to differentiate from epidemic keratoconjunctivitis. Corticosteroids should be used with caution in cases that are not completely typical of epidemic keratoconjunctivitis.