From Department of Optometry, Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders (M.P, S.S, P.S.S, S.S).
Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, CJ Shah Cornea Services, Medical Research Foundation, Chennai, India (S.A, B.S, G.I).
Am J Ophthalmol. 2022 Aug;240:187-193. doi: 10.1016/j.ajo.2022.03.004. Epub 2022 Mar 11.
To evaluate the structural and functional changes of the meibomian gland and correlate with subjective and other objective dry eye parameters in Stevens-Johnson syndrome (SJS) patients.
Prospective cross-sectional study.
This study recruited 60 patients (120 eyes) with SJS and chronic ocular sequelae. All patients underwent evaluation with a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear osmolarity, Keratograph 5M, LipiView, Schirmer's 1, corneal staining, Meibum Expression score (MES, 0-3), and Meibum Quality score (MQS, 0-3). The meibomian gland dropout area (meiboscore) was calculated for both lids and graded on a 4-point scale from 0 to 3.
The mean age of patients (n = 60) was 31.08 ± 12.94 years; 25 were males. The commonest cause for SJS, in 51 patients (85%), was drug reaction. The mean tear osmolarity, lipid layer thickness (LLT), Schirmer's test-1, and tear break-up time was 322.70 ± 17.82 mOsm/L, 53.07 ± 27.0 nm, 6.62 ± 5.74 mm, 3.38 ± 1.90 seconds, respectively. Out of 240 eyelids (both upper and lower), 160 (65%) eyelids revealed severe meibomian gland loss. The mean upper and lower lid gland loss was 77.36 ± 28.82% and 76.65 ± 29.33%, respectively, Seventy-four eyelids (61%) had no expressible glands. Meiboscore showed positive correlation with SPEED (P < .001), corneal staining scores (P < .001), MES (P < .001), and MQS (P < .001). The LLT negatively correlation with SPEED (P < .01), meiboscore (P < .001), MES (P < .01), and MQS (P < .001).
Significant alterations in anatomical and functional aspects of the meibomian gland are seen in SJS. The high meiboscore, MES, MQS, and decreased LLT contributed to the worsening dry eye state, as seen by their correlation with other dry eye parameters. This study highlights the need to evaluate meibomian gland structure and function in patients with chronic ocular sequelae of SJS.
评估史蒂文斯-约翰逊综合征（SJS）患者的睑板腺结构和功能变化，并与主观和其他客观干眼参数相关联。
前瞻性横断面研究。
本研究招募了 60 名（120 只眼）患有 SJS 和慢性眼部后遗症的患者。所有患者均接受标准患者眼干燥评估（SPEED）问卷、泪液渗透压、角膜地形图 5M、LipiView、泪膜破裂时间、角膜染色、睑板腺缺失面积（meiboscore）、睑板腺表达评分（MES，0-3）和睑板腺质量评分（MQS，0-3）评估。计算上下眼睑的睑板腺缺失面积（meiboscore），并按 0-3 分的 4 分制进行分级。
60 名患者（n=60）的平均年龄为 31.08±12.94 岁；25 名男性。51 名患者（85%）的 SJS 最常见病因是药物反应。平均泪液渗透压、脂质层厚度（LLT）、泪液分泌试验-1 和泪膜破裂时间分别为 322.70±17.82mOsm/L、53.07±27.0nm、6.62±5.74mm 和 3.38±1.90s。在 240 只眼睑（上下眼睑）中，160 只（65%）眼睑出现严重的睑板腺缺失。上、下睑腺缺失的平均值分别为 77.36±28.82%和 76.65±29.33%，74 只（61%）眼睑无分泌功能的睑板腺。睑板腺评分（meiboscore）与 SPEED（P<.001）、角膜染色评分（P<.001）、MES（P<.001）和 MQS（P<.001）呈正相关。LLT 与 SPEED（P<.01）、睑板腺评分（meiboscore）（P<.001）、MES（P<.01）和 MQS（P<.001）呈负相关。
SJS 患者的睑板腺解剖和功能方面存在明显改变。高睑板腺评分、MES、MQS 和较低的 LLT 导致干眼状态恶化，这与其与其他干眼参数的相关性有关。本研究强调了在患有 SJS 慢性眼部后遗症的患者中评估睑板腺结构和功能的必要性。
