The function and morphology of Meibomian glands in patients with thyroid eye disease: a preliminary study

Chia-Yu Wang, Ren-Wen Ho, Po-Chiung Fang, Hun-Ju Yu, Chun-Chih Chien, Chang-Chun Hsiao, Ming-Tse Kuo, Chia-Yu Wang, Ren-Wen Ho, Po-Chiung Fang, Hun-Ju Yu, Chun-Chih Chien, Chang-Chun Hsiao, Ming-Tse Kuo

Abstract

Background: To investigate function and morphology of the meibomian gland (MG) in patients with thyroid eye disease (TED).

Methods: In this prospective case series study, patients with unilateral or bilateral TED were consecutively enrolled. The diagnosis of TED was based on the typical orbital findings and/or radiographic evidence. The disease activity of TED was classified according to the clinical activity score (CAS). Degrees of lagophthalmos and exophthalmos, blinking rates, and results of the Schirmer test 1 were also recorded. All patients completed the SPEED questionnaire and underwent MG assessment, including lipid layer thickness (LLT), MG dropout (MGd), and MG expression.

Results: In total 31 eyes from 17 patients with unilateral or bilateral TED were included. Patients were divided into inactive TED (CAS 0-1; 20 eyes from 11 patients) and active TED (CAS 2-3, 11 eyes from 6 patients) groups. MGd was significantly more severe in the active TED than the inactive TED group [Median (Inter-quartile region): 3.0 (2.0-3.0) vs. 2.0 (1.0-2.0) degree, P = 0.04]. However, patients with active TED had thicker LLT than those with inactive TED (90.0 [80.0-100.0] vs. 65.0 [47.8-82.5] nm, P = 0.02), and LLT was positively correlated with lagophthalmos (r = 0.37, P = 0.04).

Conclusions: Patients with active TED had more severe MGd, but thicker LLT. Active TED may cause periglandular inflammation of MGs, leading to MGd, but compensatory secretion from residual MGs and lagophthalmos-induced forceful blinking might temporarily release more lipids over the tear film.

Keywords: Lipid layer thickness; Meibomian gland dysfunction; Thyroid eye diseases.

Conflict of interest statement

Ethics approval and consent to participate

Institutional Review Board (IRB)/Ethics Committee approval was obtained from the Committee of Medical Ethics and Human Experiments of Chang Gung Memorial Hospital (CGMH), Taiwan. Informed consent was obtained from each subject in the CGMH.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Representative photos and LipidView® II images of inactive (a, c, e) and active (b, d, f) thyroid eye diseases. a, b External eye photos of upper lid margins (OS). a) A 37-year-old female with inactive thyroid eye disease (CAS 1). Upper lid margin showed no pouting or capping of meibomian gland orifices. Only mild telangiectasia was observed. b) A 49-year-old female with active thyroid eye disease (CAS 3). Upper lid margin showed pouting and plugging of meibomian gland orifices. Telangiectasia was also present. c, d Infrared images of meibomian gland of the left lower lid. c) Grade 1 meibomian gland dropout (0−25%). d) Grade 2 meibomian gland dropout (25−50%). e, f Image of lipid layer (OS). e) Average lipid layer thickness: 79 nm f) Average lipid layer thickness: 100+ nm
Fig. 2
Fig. 2
Comparison between active and inactive thyroid eye diseases (TED) for meibomian gland dropout (MGd), meibomian gland expression, including meibomian gland expressibility (MGE), meibomian gland yielding liquid secretion (MGYLS), and total meibum quality score (TMQS), as well as lipid layer thickness (LLT), and partial blinking rate, by boxplot diagrams. The dot in Fig. 2b shows the 2 outliers of MGE in CAS 2−3. Box, 25th to 75th percentile; bold line in the box, median; bars, minimum and maximum values; dot, outliers
Fig. 3
Fig. 3
Correlation between meibomian gland dropout (MGd) and exophthalmos, lagophthalmos, and blinking rate, respectively (a−c). Correlation between lipid layer thickness (LLT) and exophthalmos, lagophthalmos, and blinking rate, respectively (d−f). (○), inactive TED eye (CAS 0−1); (●), active TED eye (CAS 2−3)

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