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Comparison of Meibomian Gland Loss and Expressed Meibum Grade Between the Upper and Lower Eyelids in Patients With Obstructive Meibomian Gland Dysfunction

Eom, Youngsub MD; Choi, Kwang-Eon MD; Kang, Su-Yeon MD; Lee, Hyung Keun MD, PhD; Kim, Hyo Myung MD, PhD; Song, Jong Suk MD, PhD

doi: 10.1097/ICO.0000000000000092
Clinical Science

Purpose: The aim of this study was to compare meibomian gland loss (MGL) and expressed meibum grade between upper and lower eyelids in patients with obstructive meibomian gland dysfunction (MGD) and to evaluate the correlation between these 2 parameters and other clinical measurements.

Methods: Twenty-six eyes of 26 patients with obstructive MGD were enrolled. Upper and lower MGLs were evaluated using noncontact meibography. Expressed meibum quality was assessed in 8 glands of the central third area of the upper and lower eyelids on a scale of 0 to 3 for each gland (total score range, 0–24). Tear film stability was evaluated based on tear break-up time (TBUT), and corneal staining was graded according to the National Eye Institute scale (range, 0–15).

Results: The mean MGL in the lower eyelids (24.1% ± 10.8%) was significantly greater than that of the upper eyelids (11.2% ± 5.2%) (P < 0.001). The mean expressed meibum grade in the lower eyelids (16.5 ± 5.1) was also significantly larger than that of the upper eyelids (11.2 ± 5.2) (P < 0.001). MGL was significantly correlated with expressed meibum grade in both eyelids (r = 0.451, P = 0.021 in the upper eyelids; r = 0.626, P = 0.001 in the lower eyelids). The meibum grades of both the upper and lower eyelids were negatively correlated with TBUT and positively correlated with corneal staining score. However, the MGL in both the eyelids was not correlated with TBUT or with corneal staining score.

Conclusions: In patients with obstructive MGD, MGL and meibum grade in the lower eyelids were significantly greater than those of the upper eyelids. Although MGL and meibum quality showed a positive correlation with each other, TBUT and corneal staining score were significantly correlated with only meibum grade, and not with MGL.

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*Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea; and

Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.

Reprints: Jong Suk Song, Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152–703, South Korea (e-mail:

Supported by a grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI13C0055).

Presented in part at the seventh International Conference on the Tear Film & Ocular Surface: Basic Science and Clinical Relevance, September 18–21, 2013, Taormina, Sicily.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 01, 2013

Accepted January 14, 2014

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.