PURPOSE: To compare clinical findings between patients with obstructive
meibomian gland dysfunction (MGD) and normal controls and to propose diagnostic criteria for obstructive MGD. DESIGN:
Cross-sectional, observational case series. PARTICIPANTS: Fifty-three
eyes of 53 patients (18 men, 35 women; age [
mean +/-
standard deviation] 71.4 +/- 10.0 years) who were diagnosed with obstructive MGD and 60
eyes of 60 healthy volunteers (22 men, 38 women; 71.0 +/- 9.3 years) as a control group. METHODS: Ocular
symptoms were scored from 0 to 14 according to the number of existing
symptoms. Lid margin abnormality was scored from 0 to 4 depending on the number of existing abnormalities.
Meibomian gland changes were scored from 0 to 6 based on noncontact meibography (meibo-score). Superficial punctuate keratopathy (SPK) was scored from 0 to 3. Meibum was graded from 0 to 3 depending on the volume and quality.
Tear film production was evaluated by
Schirmer's test.
Receiver operating characteristic curves with calculations of area under the curve (AUC) were used to describe the
accuracy of each parameter to differentiate obstructive MGD from normal
eyes. MAIN OUTCOME MEASURES: Ocular
symptom score, lid margin abnormality score, meibo-score, meibum score, SPK score,
tear film breakup time (BUT), and the Schirmer value. RESULTS: Ocular
symptom score, lid margin abnormality score, meibo-score, meibum score, and SPK score were significantly higher in the obstructive MGD group than in the control group (P<0.0001 for all scores). The BUT was significantly shorter in the obstructive MGD group than in the control group (P<0.0001). The AUC values indicated that the ocular
symptom score had the highest diagnostic power as a single parameter, followed by the lid margin abnormality score, meibo-score, and BUT. CONCLUSIONS: Based on these findings, we recommend that physicians use the ocular
symptom score, lid margin abnormality score, and meibo-score to diagnose MGD. Obstructive MGD should be suspected when any 2 of the 3 scores are abnormal. Obstructive MGD is very likely when all 3 scores are abnormal.
