The authors evaluate long-term structural and functional meibomian gland and lid margin changes in a retrospective study of 64 patients (64 eyes) with chronic cicatricial conjunctival diseases (CCDs), including ocular cicatricial pemphigoid (OCP; n=22), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN; n=24), and graft-versus-host disease (GVHD; n=18). Using the ‘Cicatrising Conjunctivitis Assessment Tool’ clinical findings were categorised into inflammation and scar-morbidity scores, which were correlated with tear film parameters, meibomian gland dysfunction (MGD), lid margin keratinisation and ocular surface disease index (OSDI) scores. Meibomian gland dysfunction and dry eye were the most common chronic findings. Ocular cicatricial pemphigoid patients demonstrated significantly higher composite scar-morbidity scores, poorer visual acuity (mean 1.57logMAR), and more severe MGD parameters compared to SJS-TEN and GVHD groups. Conversely, GVHD patients exhibited the highest dry eye symptom burden (mean OSDI 61.23). Statistically significant positive correlations were identified between scar-morbidity scores and MGD parameters impaired gland expression (r=0.426, p<0.001), altered secretion quality (r=0.425, p<0.001), lid margin changes (r=0.439, p<0.001) as well as OSDI scores (r=0.506, p<0.001). Lid margin keratinisation occurred in 38.7% of eyes, strongly correlating with MGD presence (r=0.721, p<0.001) and surgical procedures, including amniotic membrane transplantation and mucous membrane grafting. The authors conclude that MGD and lid margin keratinisation strongly dictate long-term ocular surface survival and visual recovery in chronic CCDs. Despite retrospective design and sample size limitations, this study highlights the need to incorporate semiquantitative MGD and tear film metrics into standardised scoring tools to optimise patient monitoring and surgical planning.
Ocular surface and meibomian gland changes in cicatricial conjunctival disease
Reviewed by Anitha Priya Arun Shankar
Relationship between chronic ocular surface and meibomian gland changes and clinical assessment tool in cicatricial conjunctival diseases.
