A Case of Absence of Meibomian Glands in the Lower Eyelids of A Middle-Aged Female in Abuja, Nigeria.

The absence of the Meibomian gland is a rare cause of evaporative dry eye disease. A 45year old Lady, a known patient of our clinic whom we have been managing for allergic conjunctivitis for the past 5 years, started complaining of her eyes feeling dry and foreign body sensation 2 years ago. Her ocular surface disease index was 12.5, dry eye symptom score was 7 out of 14. She had no Meibomian orifices on her lower lid margin, but the upper lid orifices were present in both eyes, with normal expression of fluid when expressed. There were 23 and 25 Meibomian orifices opening in the upper lids respectively, the meiboscore in both upper lids were 0 and in both lower lids were 3, the tear film breakup time was 2 seconds in both eyes, the Schirmer's test I was 5mm and 7mm, the Schirmer's test II was 3 and 6 mm in the right and left eye respectively. The conjunctiva was normal, the cornea in the right eye had punctate epithelial erosions in the inferior 1/3 of the cornea, and the left cornea was not stained. Other than these findings the anterior and posterior segment were essentially normal. Anterior segment OCT pictures of the everted lids showed the Meibomian gland superiorly and these were absent inferiorly. She has been placed on Gutt Sodium Hyaluronate 0.2%, 3 hourly, and OcHypromellose Opthalmic Gel 0.3% enriched with Carbomer 980 USP 0.25% at night. She says her symptoms resolved while on these medications. Although the congenital absence of the Meibomian gland is rare, they can present late with dry eye symptoms and mimic allergic conjunctivitis symptoms. We should examine the Meibomian orifices of all our patients to identify those with these abnormalities early. The report also highlights the importance of anterior segment OCT in evaluating the Meibomian gland.