Abnormal Property Of Meibomian Secretion And Dry Eye Syndrome Caused By Lipid Tear Deficiency

Objective: To investigate the feature of the abnormal property of Meibomian secretion and dry eye syndrome caused by lipid tear deficiency(LTD) and the relationship between them, to survey the different treatment outcome between Meibomian gland compression and common antibiotic eye drops plus artifical tears, to probe the relationship between inflammation and abnormal secretion.Methods: 72 cases of outpatients with abnormal Meibomian secretion were investigated by questionnaire, the score of ocular discomfort depends on 10 symptoms each symptom scores 0, 1, 2, 3 according to the suffering degree ranged from none, mild, medium to severe, the total score is 30. Routine examination include visual acuity and best corrected visual acuity, anterior segment and fundus examination, Tear Break Up Time (BUT) and Fluorescein staining examination that have a total score of 12 with each quarter of the cornea scores 0, 1, 2, 3 according to the degree of the staining that range from none, mild, medium to severe, Schirmer I Test is performed and recorded. The score of each patient is the average of the two eyes. Among them, all those meet with the diagnostic criteria of LTD were randomly distributed to treatment group and control group paired by the secretion property. Treatment group was treated with Meibomian gland compression mainly and control group with common antibiotic eye drops plus artifical tears. The follow up time is 6 month and 2 month in treatment group and control group relatively. All abnormal secretions were smeared on slides, stained by Wright and underwent microscope examination.Results: 32 cases with 64 eyes meet the diagnostic criteria of LTD, each group has 16 patients. The age of patients with abnormal Meibomian secretion range from 29 to 78years, the average is 47.9?.3 years, among them, 24 cases have milk-yellowish secretion, 20 cases have granular secretion and 28 cases have toothpaste-like secretion. The discomfort score in toothpaste-like secretion group is 16.6 + 3.4 which ranks the highest among the three groups, and BUT is 4.3 + 3.2 seconds which ranks the lowest among the three groups, the difference is significant statistically. LTD is related to Meibomian secretion property, 22 out of 28 cases (78.6%) in the toothpaste-like secretion group have been diagnosed LTD, people with toothpaste-like secretion is more easily to have LTD. In treatment group, ocular discomfort score is 17.1+3.2 and 4.2+1.2; BUT 3.8 + 1.2 seconds and 8.9+1.3 seconds; Fluorescein staining score 9.2 + 1.1 and 3.9 ?1.0 pre and post treatment relatively, the difference is significant statistically. 4 weeks post treatment, ocular discomfort score is 4.2?1.2 and 14.1 ?2.2; BUT 8.9+1.3 seconds and 4.4 ?1.7 seconds; Fluorescein staining score 3.9 +1.0 and 8.2 ?1.6 in treatment group and contrast group relatively, the difference is significant statistically. Schirmer Test is within the normal range in the cases with abnormal secretion and LTD. 69 cases of abnormal secretions, which had been smeared and stained were found containing few epithalial cells and inflammatory cells, while 3 cases of milk-yellowish secretions containing a large number of inflammatory cells and few epithalial cells.Conclusion: The abnormal Meibomian secretion are mostly distributed in middle and aged people. Toothpaste-like secretion contributes to the ocular discomfort and LTD more. LTD occupied a great portion in the patients with abnormal Meibomian secretion, the aqueous tear secretion is normal in LTD. Meibomian compression can release the symptoms quickly, prolong the BUT and decrease the staining in the ocular surface, it has a better curing results compared to common antibiotic eye drops plus artifical tears. Only a small portion in abnormal Meibomian secretion are related to inflammation.