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Changes in the Evaporation Rate of Tear Film After Digital Expression of Meibomian Glands in Patients With and Without Dry Eye

Arciniega, Juan Carlos MD; Wojtowicz, Jadwiga Cristina MD; Mohamed, Engy Mostafa MD; McCulley, James Parker MD, FACS, FRCOphth(UK)

doi: 10.1097/ICO.0b013e31820cd291
Clinical Science

Purpose: To evaluate the effect of excess meibum on tear evaporation rate in patients with and without dry eye.

Methods: Eleven healthy subjects and 16 patients with dry eye were tested. The dry eye group was divided into 2 subgroups: classic keratoconjunctivitis sicca (KCS) with clear and easily expressed meibum and KCS with meibomian gland dysfunction (MGD) with turbid secretions and difficult-to-express meibum. Evaporative measurements were performed at baseline and after digital expression of meibomian glands at 12, 24, 36, and 48 minutes. Two ranges of relative humidity were used, 25% to 35% and 35% to 45%. The data were expressed as microliters per square centimeter per minute.

Results: An increase in the evaporation rate of the tear film was noted for all measurements at both relative humidities in the classic KCS and KCS with MGD groups compared with healthy subjects (P < 0.05). The average evaporation rates at relative humidities of 25% to 35% and 35% to 45% were 0.056 ± 0.016 and 0.040 ± 0.008 for the classic KCS group; 0.055 ± 0.026 and 0.037 ± 0.019 for the KCS with MGD group and 0.033 ± 0.012 and 0.023 ± 0.008 for the healthy group. Also, a decrease in the evaporation rate was observed in the healthy and KCS with MGD groups between baseline and the first measurement after digital expression for both relative humidities (P < 0.05). The classic KCS group did not show any changes after expression.

Conclusions: Classic KCS and KCS with MGD groups showed an increase in tear evaporation rates compared with the healthy group. Aqueous tear evaporation diminished in the healthy and KCS with MGD groups after expression of meibomian glands. However, this effect was transient and negligible after the second measurement.

From the Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, TX.

Received for publication March 5, 2010; revision received November 30, 2010; accepted November 30, 2010.

Supported in part by grants NIH EY12430, EY016664, an unrestricted grant from the Research to Prevent Blindness, New York, NY, and Advanced Vision Research.

Reprints: James Parker McCulley, Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9057 (e-mail:

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