Abstract
In recent years attention has been paid to meibomian gland dysfunction (MGD) as a distinct clinical entity responsible for chronic symptoms and signs and occurring independently or in association with atopy, cicatrising mucosal disorders and rosacea. Attempts to correlate MGD with microbiological and lipid biochemical changes are confounded by the absence of a clear descriptive language for the disorder and its associated changes. Such a language is crucial for the conduct of cross-sectional and natural history studies and therapeutic clinical trials. We present a comprehensive classification and grading scheme of meibomian gland disease, supporting our observations with illustrations.
Similar content being viewed by others
Article PDF
References
Jester JV, Nicholaides N, Smith RE : Meibomian gland dysfunction. I. Keratin protein expression in normal human and rabbit meibomian glands. Invest Ophthalmol Vis Sci 1989a, 30: 927–35.
Meibomius H : De Vasis palpebrarum Novis Epis-tola p.23. Müller, Helmstädt.
Neumann F and Elger W : The effect of a new anti-androgenic steroid, 6-Chloro-17-Hydroxy-1α, 2α Methylene Pregna-4, 6-Diene-3, 20 Dione Acetate (Cyproterone Acetate) on the sebaceous glands of mice. J Invest Dermatol 1966, 46: 561–72.
Strauss JS and Pochi PE : Assay of anti-androgens in man by the sebaceous gland response. Br J Dermatol 1970, 82 (Suppl 60): 33–42.
Schuster S and Thody AJ : The control and measurement of sebum secretion. J Invest Dermatol 1974, 62: 172–90.
Zaun H : Zur hormonelle Beeinflussung der Talgsek-retion. Fette Seife Anstrichtsmittel 1979, 81: 130–3.
Zlotogorski A, Glaser B, Berovici B, Dikstein S : Sebum measurements for rapid identification of hyperandrogenism. (in press).
Hartschuh W, Weihe E, Reinecke M : Peptidergic (neurotensin, VIP, substance P) nerve fibres in the skin. Immunohistochemical evidence of an involvement of neuropeptides in nociception, pru-ritis and inflammation. Br J Dermatol 1983, 109 (Suppl 25): 14–7.
Buschke A and Fränkel A : Ueber die Funktion der Talgdrusen und deren Beziehung zum Fettstoff-weschel. Berlin-Klin Wshcr 1905, 24: 318–22.
Jester JV, Rife L, Nii D, Luttrull JK, Wilson L, Smith RE : In vivo biomicroscopy and photography of meibomian glands in a rabbit model of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 1982, 22: 660–7.
Jester JV, Nicholaides N, Kiss-Polvolgyi I, Smith RE : Meibomian Gland Dysfunction. II: The role of keratinisation in a rabbit model of MGD. Invest Ophthalmol Vis Sci 1989b, 30: 936–45.
Killey FP, Minckler DS, Smith RE, Spencer JA : The effect of long term epinephrine in the rabbit eye. (ARVO abstracts). Invest Ophthalmol Vis Sci 1980, 19 (Suppl): 253.
Tiffany JM and Dart JKG : Normal and abnormal functions of meibomian gland secretions. Roy Soc Med Int Congr Symp Ser 1981, 40: 1061–4.
Wolff E : The mucocutaneous function of the lid margin and the distribution of the tear fluid. Trans Ophthalmol Soc UK 1946, 66: 291–308.
Linton RG, Curnow DH, Riley WJ : The meibomian glands: An investigation into the secretion and some aspects of the physiology. Br J Ophthalmol 1961, 45: 718–23.
McDonald JE : Surface phenomena of tear films. Trans Am Ophthal Soc 1968, 66: 905–9.
Josephson JE : Appearance of the preocular tear film lipid layer. Am J Optom Physiol 1983, 60: 883–7.
Tiffany JM : The lipid secretion of the meibomian glands. Adv Lipid Res 1987, 22: 1–62.
Tiffany JM : The role of meibomian secretion in the tears. Trans Ophthalmol Soc UK 1985, 104: 396–401.
Nicolaides N : Recent finding on the chemical composition of the lipids of steer and human meibomian glands. In ‘The Preocular Tear Film’ ed F. Holly, pp. 570–596 Dry Eye Institute, Lubbock, Texas 1986.
Virchow H : Microscopic anatomy of the outer coats of the eye and the lids (German). In ‘Graefe-Sae-misch Handbuch der gesamten Augenheilkunde’ ed T. Saemisch, 1910, Vol 1, Part 1, Ch 2.
Duke Elder WS and Wybar KC : The anatomy of the visual system. Vol II of the system of Ophthalmology. H Kimpton, London 1961.
Wolffe E : Anatomy of the Eye and Orbit. Seventh edition. Ed R Warwick 1976. HK Lewis, London.
Murube del Castillo J : Dacriologia Basica p 432. Soc Esp Oftal, Las Palmas 1981.
Bron AJ and Mengher LS : Congenital deficiency of meibomian glands. Br J Ophthalmol 1987, 71: 312–4.
Holly FJ and Lemp MA : Tear physiology and dry eyes. Surv Ophthalmol 1977, 22: 69–87.
Baum JL and Bull MJ : Ocular manifestations of the ectrodactyly, ectodermal dysplasia, cleft lip-palate syndrome. Am J Ophthalmol 1974, 78: 211–16.
Mondino BJ, Bath PE, Foos RY, Apt L, Rajacich GM : Absent meibomian glands in the ectrodactyly ectodermal dysplasia, cleft lip-palate syndrome. Am J Ophthalmol 1984, 97: 496–500.
Bron AJ, Tiffany JMT, Kaura R, Mengher LS : Disorders of tear lipids and mucous glycoproteins. In: DL Easty, GS Molin eds. External eye disease. London: Butterworths 1984. 63–105 Theodore.
Korb DR and Henriquez AS : Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc 1980, 51: 243–51.
Henriquez AS and Korb DR : Meibomian glands and contact lens wear. Br J Ophthalmol 1981, 65: 108–11.
Gutgesell VJ, Stern GA, Hood CI : Histopathology of meibomian gland dysfunction. Am J Ophthalmol 1982, 94: 383–7.
Kieth CG : Seborrhoeic blepharo-kerato-conjunctivitis. Trans Ophthalmol Soc UK 1967, 87: 85–103.
Tapie R : Etude biomicroscopique des glandes de Meibomius. Ann Oculist 1977, 210: 637–48.
Robin JB, Jester JV, Nobe J, Nicolaides N, Smith: In vivo transillumination biomicroscopy and photography of meibomian gland dysfunction. Ophthalmology 1985, 92: 1423–6.
Gifford SR : Meibomian glands in chronic blepharo-conjunctivitis. Am J Ophthalmol 1921, 4: 489–94.
Duke-Elder S : System of Ophthalmol. XIII. The Ocular Adnexa. Part I Diseases of the eyelids. p. 241–250, Sir S Duke-Elder and PA MacFaul. Pub. H Kimpton, London 1974.
Deyl : Ueber die Ätiologie der Chalazion, Prague 1893.
Dianoux : La conjonctivite a chalazion. Arch d'Ophthal 1891, 11: 302.
Norn MS : Natural fats in external eye. Vital stained by Sudan III. Acta Ophthalmol 1980 58: 331–6.
Norn MS : Meibomian orifices and Marx's line. Studied by triple staining. Acta Ophthamol 1985, 63: 689–700.
Norn MS : Foam at outer palpebral canthus. Acta Ophthalmol 1963, 41: 531–7.
Mackenzie : A practical treatise on diseases of the eye. 2nd edition. London P. 149. 1835.
Scarpa : Arch di Otti 1897, 82.
Elschnig A : Die massage in der Augenheilkunde. Wiener medizinischen presse 1901 no. 18 und 19.
Elschnig A : Beitrag zur Aetiologie und therapie der chronischen conjunctivitis. Deutsch med Wschr 1908, 34: 1133.
Addario : Sci di un caso di calazio multiplo e di tarsite cronica diffusa di tutte e quattro le palpebre. Ann di Ott 1988, 17: 259.
Natanson A : Chronische multiple eitrige Entzün-dung der Meibomschen Drusen. Klin Mbl. f. Augenhlk 1907, 45: 529.
McCulley JP, Dougherty JM, Deneau DG : Classification of chronic blepharitis. Ophthalmology 1982, 89: 1173–80.
McCulley JP and Sciallis CF : Meibomian keratoconjunctivitis. Am J Ophthmol 1977, 84: 788–93.
Thygeson P : Etiology and treatment of blepharitis. A study in military personnel. Arch Ophthalmol 1946, 36: 445–77.
Cowper HW : Meibomian seborrhoea. Am J Ophthalmol 1922, 5: 25–30.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bron, A., Benjamin, L. & Snibson, G. Meibomian gland disease. Classification and grading of lid changes. Eye 5, 395–411 (1991). https://doi.org/10.1038/eye.1991.65
Issue Date:
DOI: https://doi.org/10.1038/eye.1991.65
This article is cited by
-
Effects of climate factors and Demodex infestation on meibomian gland dysfunction-associated dry eye diseases
Scientific Reports (2024)
-
Higher incidence of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction
International Ophthalmology (2024)
-
Changes in the meibomian glands in postmenopausal women with primary acquired nasolacrimal duct obstruction: a prospective study
BMC Ophthalmology (2023)
-
Ocular surface involvement and histopathologic changes in the acute stage of Stevens-Johnson syndrome and toxic epidermal necrolysis: a cross-sectional study
BMC Ophthalmology (2023)
-
Evaluation of meibomian gland dysfunction in type 2 diabetes with dry eye disease: a non-randomized controlled trial
BMC Ophthalmology (2023)