Screening for meibomian gland disease: its relation to dry eye subtypes and symptoms in a tertiary referral clinic in singapore.

PURPOSE. To study screening methods and associated factors of Meibomian gland disease and dry eye subtypes in a specialized eye clinic in Singapore. METHODS. This cross-sectional study involved 200 patients in a dry eye clinic. The outcome measures evaluated were dysfunctional tear syndrome (DTS) level, meibomian gland disease grade, Schirmer test (ST) result, fluorescein tear break-up time (TBUT), corneal fluorescein staining grade, and irritative eye symptoms. RESULTS. The meibomian gland screening grade was associated with TBUT (P = 0.007), especially in the upper eyelid and correlated with reading difficulty (P = 0.007) and reversibility of symptomatic blurring with lubricants (P = 0.006). An abnormal ST result was associated with early morning discomfort (P = 0.001), and reduced TBUT was linked to discomfort in windy conditions (P < 0.001). In all patients examined, evaporative dry eye (58%) was the most common type, followed by the mixed evaporative and aqueous tear deficiency (30.5%) types. Fluorescein staining in the central and inferior cornea was most severe in the mixed type. CONCLUSIONS. In dry eye patients, screening for meibomian gland disease based on anteriorization of Marx's line may predict a decrease in TBUT and difficulty in performing certain visual-function-related activities. These findings facilitate better understanding of the meibomian gland's contribution to multifactorial dry eye syndrome, apart from routine conventional tests performed in clinics.