This article was originally published in a sponsored newsletter.

Meibomian gland dysfunction (MGD) is a common condition that is present in 86% of dry eye patients.¹ MGD is the most universal reason of evaporative dry eye,² and patients may be asymptomatic or symptomatic. Gland expression can be used to detect MGD in asymptomatic cases. If MGD is symptomatic, it may be associated with either local or systemic clinical signs such as acne rosacea, seborrhea sicca, atopic dermatitis, and cicatrizing conjunctival disorders such as Stevens-Johnson syndrome or trachoma.³
 
There are four subtypes of MGD: 1) Either asymptomatic or symptomatic MGD that is (noncicatricial, cicatricial) without other findings; 2) MGD that is associated with damage of the ocular surface; 3) Evaporative dry eye that is related to MGD; and 4) MGD that is correlated with other ocular disorders.³
 
To evaluate MGD, it is crucial to examine the lids and lid margins, along with the quality and quantity of the meibum. Obvious signs of MGD include gland inspissation and inflammation of the eyelids. More subtle signs of MGD include abnormal quality and quantity of meibum and tear film debris. Meibography or gently pressing on the lids can illustrate whether an obstruction is present.

A review article evaluated 115 publications and found 22 articles on the association between MGD and contact lens wear.² Seven publications reported no substantial impact of contact lens wear on meibomian glands. However, 15 publications reported that the function and morphology of meibomian glands are affected by contact lens wear.
 
A recent publication used infrared meibography with a fundus camera to assess meibomian glands and meibomian gland dropout in scleral lens wearers.⁴ In 43 scleral lens wearers, the results were repeatable and ocular symptoms were reduced. There were not any differences that were statistically significant with gland visibility metrics and gland drop-out.
 
These studies reinforce the importance to evaluate the ocular surface and specifically the meibomian glands in scleral lens wearers. Future longitudinal prospective studies of scleral lens wearers and non-wearers are needed to confirm the relationship between MGD and scleral lens wear.

REFERENCES

1. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May;31:472-478.

2. Ifrah R, Quevedo L, Gantz L. Topical review of the relationship between contact lens wear and meibomian gland dysfunction. J Optom. 2023 Jan-Mar;16:12-19.

3. Tomlinson A, Bron AJ, Korb DR, et al. The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. Invest Ophthalmol Vis Sci. 2011 Mar 30;52:2006-2049.

4. García-Marqués JV, Macedo-De-Araújo RJ, Cerviño A, García-Lázaro S, González-Méijome JM. Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study. Cont Lens Anterior Eye. 2023 Feb;46:101571.

Melissa Barnett, OD, FAAO, FSLS s a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Mojo Vision, Ocusoft, ScienceBased Health, Shire, SynergEyes, Tarsus, and Visus Therapeutics.