|Year : 2019 | Volume
| Issue : 4 | Page : 346-351
Association of meibomian gland dysfunction with dyslipidemia contributors
Shashank Banait, Yash Hada
Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical sciences, Wardha, Maharashtra, India
|Date of Submission||29-Nov-2019|
|Date of Decision||20-Dec-2019|
|Date of Acceptance||27-Dec-2019|
|Date of Web Publication||16-Jul-2020|
Dr. Shashank Banait
Department of Ophthalmology, DMIMS (DU), Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
Aims: To determine the association between dyslipidemia and MGD. Settings and Design: It is a prospective, observational study of 1 year duration. Thirty patients who were diagnosed with meibomian gland dysfunction and 30 age and sex matched controls were taken into study after they gave their informed consent and taking into consideration the inclusion and exclusion criteria. Methods and Material: After enrollment of the subject to the study all subjects had undergone a thorough ophthalmic examination. Tear film break up time, Schirmer's Test without anesthesia followed by with anesthesia was calculated. Statistical analysis used: Meibomian gland status was evaluated by, expressibility, and numerical scoring of staining. test was done by taking venous sample of blood in a red-topped vacutainer after overnight fasting. Values of total cholesterol (TC), high-density lipoprotein (HDL) , low-density lipoprotein (LDL), and triglycerides (TGs) were noted. Results: There exists an association between increasing stage of MGD and age and increasing values of TC,LDL,TGs of lipid profile.Conclusions: Higher stages of MGD are associated with increased age. MGD and increasing levels of LDL, total cholesterol, and triglycerides have a positive correlation.
Keywords: Dyslipidemia, hyperproteinemia, hypercholesterolemia, hypertriglyceridemia, meibomian gland dysfunction, obesity
|How to cite this article:|
Banait S, Hada Y. Association of meibomian gland dysfunction with dyslipidemia contributors. J Datta Meghe Inst Med Sci Univ 2019;14:346-51
| Introduction|| |
Meibomian gland More Details dysfunction (MGD) is defined as a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. This may result in the alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease. Meibomian glands contribute to the lipid component of the tear film, and their normal secretion prevents premature evaporation of tears from the ocular surface. Their secretions consist of a complex mixture of various polar and nonpolar lipids containing cholesterol and wax esters, diesters, triacylglycrides, free cholesterol, free fatty acids, and phospholipids. With a number of changes in lifestyle involving dietary preferences, work habits, and the advent of computer usage in all spheres of life, the incidence and prevalence of dry eye has increased dramatically in the general population. MGD may be the leading cause of dry eye disease throughout the world, but is often overlooked in busy outpatient settings.
| Subjects and Methods|| |
The study is a prospective, observational, case–control study.
This is a tertiary care teaching hospital-based study done in the Department of Ophthalmology, AVBRH, Sawangi, Wardha, Maharashtra.
The study was done over a period of 1 year from September 2018 to September 2019.
The sample size included thirty patients as cases and thirty as controls.
Subjects and selection methods
Thirty sequentially collected patients diagnosed with MGD together with thirty age- and sex-matched controls were enrolled.
Procedure for test
Assessment of the patient was done with the help of (a) complete ophthalmic examination which includes assessment of the lacrimal system for any abnormality and (b) assessment of the meibomian gland, which was done by putting pressure at the middle one-third of both upper and lower eyelids while observing under the slit lamp. The diagnosis of MGD was done by criteria based on the international workshop of MGD. Lipid profile test was done by taking venous sample of blood in a plain vial after overnight fasting and was done using VITROS 5600 by Ortho Clinical Diagnostics, Raritan, NJ Parameters taken into account were as follows:
- Triglycerides (TGs): Hypertriglyceridemia >150 mg/dl
- Total cholesterol (TC): Hypercholesterolemia >200 mg/dl
- Low-density lipoprotein (LDL)-cholesterol (LDL-C): High LDL >130 mg/dl
- High-density lipoprotein (HDL)-cholesterol (HDL-C): High HDL >40 mg/dl.
Diagnosis of MGD:
- Meibum quality was assessed in each of the eight glands of the central third of the lower eyelid on a 0–3 scale for each gland:
- 0 = Clear meibum
- 1 = Cloudy meibum
- 2 = Cloudy with debris
- 3 = Thick toothpaste (range 0–24).
Expressibility of meibum: Assessed from the five glands of the central third of the lower eyelid on a scale of 1–3:
- 1 = 3–4 glands expressible
- 2 = 1–2 glands expressible
- 3 = No glands expressible.
Numerical staining: Scores refer to a summed score of staining of the exposed cornea and conjunctiva. Fluorescein stains were used. The Oxford scale has a range of 0–15.
- Patients who were aged 18 years and above
- Those who gave valid consent.
- Patients below the age of 18 years
- Patients not giving valid consent
- Recent ocular surgery
- Treatment with topical steroid 4 weeks before the study
- Changes in the drainage system of the lacrimal apparatus
- Ongoing glaucoma medications
- Patients suffering from keratoconjunctivitis of infectious type
- Patients who are on oral contraceptive pill
- Patients on antihypertensive medication
- Pregnant women
- Patient with rosacea, Sjogren's syndrome, cholestatic liver disease, and Parkinsonism More Details.
Statistical analysis used
The list of patients diagnosed with dyslipidemia and MGD was entered in Microsoft Excel spreadsheet, and the Statistical Package for the Social Sciences (SPSS) version 24.0 (Chicago, Illinois, USA) was used to analyze the data. The correlation between age and stage was assessed by Spearman's correlation coefficient. P < 0.05 was considered statistically significant.
Ethical clearance was obtained from the Institutional Ethical Committee of JNMC, Sawangi (Meghe), Wardha, on 19th May 2019. With ethical clearance no DMIMS(DU)/IEC/2019-20/332.
| Discussion|| |
A total of thirty cases and thirty controls were taken into the study. Both of these were age and sex matched. The percentage of patients in the age group of 31–40 years was 3.33, in 41–50 was 5, 51–60 was 31.67, 61–70 was 50, and 71–80 was 10. Majority of patients were in the age group of 61–70 years and least were in the age group of 31–40 years [Table 1] and [Graph 1].
On calculating the number of patients in each stage, majority of cases were in Stage 2 (50%) and most of them (30%) were in the age group of 61–70 years. The age group of 51–60 years had 20% of these patients. The percentage of patients in Stage 3 was 26.6 of all cases, with majority in the age group of 61–70 years (20%). A least number of patients were in Stage 4 (10%). Stage 1 had 13.33% of the cases, and all of these were under the age group of 31–50 years [Table 2] and [Graph 2].
The number of patients in higher stages of MGD increased as the age range increased. This shows a positive correlation with increasing age and stages of MGD [Table 3] and [Graph 3]. The standard deviation of age was 7.92 and that of grades of MGD was 0.84.
|Table 3: Age distribution of cases and stages of meibomian gland dysfunction|
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Stage 1 shared equal number of males and females. Out of the thirty cases enrolled, 15 were male and the rest were female. The maximum number of cases was in Stage 2, which had 23.33% of cases as males and 26.60% as females. In Stage 3, sex ratio was 10% of males and 16% of females. No female was found to have Stage 4 of MGD [Table 4].
|Table 4: Correlation of age with stage of meibomian gland dysfunction in cases; Spearman's rank-order correlation|
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The number of MGD patients with TGs of <150 mg/dl was 19 (60%), whereas >150 mg/dl was 12 (40%). Majority of patients with TGs <150 belonged to Stage 2, i.e. 6 (20%), whereas a least number of patients were in Stage 4, i.e. 1 (3.33%) [Table 5] and [Graph 4].
|Table 5: Sex-wise distribution and stages of meibomian gland dysfunction|
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The number of patients with TC <200 mg/dl was 24 (80%), whereas 6 (20%) had values above 200. Majority of patients with TC <200 mg/dl were in Stage 2, i.e. 7 (23.33%), whereas minimum were in Stage 1, i.e. 4 (13.32%). No such patients were present in Stage 4. Majority of patients with TC >200 mg/dl were in Stage 4, i.e. 3 (10%), whereas none were present in Stages 1 and 2 [Table 6] and [Graph 5].
The total number of patients with LDL >130 mg/dl was 7 (23.33%), whereas those with LDL <130 mg/dl was 23 (765.66%). Majority of patients with LDL >130 mg/dl were in Stage 4 (10%), whereas no patients were seen in Stages 1 and 2. With LDL <130 mg/dl, majority of patients were in Stage 2 (50%), whereas Stage 4 had no such patients [Table 7] and [Graph 6].
The total number of patients with HDL >40 mg/dl was 13 (43.33%) and <40 mg/dl was 17 (56.66%). Majority of patients with HDL >40 mg/dl were in Stage 2 (26.66), whereas no patients were present in Stage 1. Majority of patients with HDL <40 mg/dl were in Stage 2 (23.33%), whereas minimum were in Stage 4 (6.66%) [Table 8] and [Graph 7].
In controls, patients having TC level <200 mg/dl were 70%, whereas with those with >200 mg/dl were 30%. The level of HDL with <40 mg/dl was 53.34% and in >40 mg/dl, it was 46.66%. In LDL, levels <130 mg/dl were seen in 90% of the controls, whereas it was >130 mg/dl only in 10% of the controls. Similarly, the level of TG was <150 mg/dl in 80% of controls, whereas it was >150 mg/dl in 20% [Table 9].
| Results|| |
The result of this study shows that there is a positive correlation between age and stages of MGD. The statistic calculation by Spearman's rank-order correlation shows a positive correlation and a rho valve of 0.772 and P = 0.0001 as statistically significant.
Along with this, there is a significant correlation with an increased level of TC. The number of MGD patients with TC <200 mg/dl and >200 mg/dl in our study was 24 (80%) and 6 (20%), respectively. Majority of patients with TC <200 mg/dl belonged to Stage 2, whereas a minimum number of patients with TC >200 mg/dl belonged to Stage 4. As P < 0.002, it indicates a strong association between hypercholesterolemia (levels >200 mg/dl) and increasing severity of stage of MGD.
The number of MGD patients with TGs <150 mg/dl and >150 mg/dl in our study was 18 (60%) and 12 (40%), respectively. Majority of patients with TGs <150 mg/dl belonged to Stage 2, whereas a minimum number of patients with TC >200 mg/dl belonged to Stage 3. As the P value was <0.0234, it indicates a strong association between hypercholesterolemia (levels >200 mg/dl) and increasing severity of stage of MGD and LDL levels. The number of MGD patients with LDL <130 mg/dl and >130 mg/dl in our study was 23 (76.66%) and 7 (23.33%), respectively. Majority of patients with TC <130 mg/dl belonged to Stage 2, whereas a minimum number of patients with TC >200 mg/dl belonged to Stage 3. As the P value was <0.0033, it indicates a strong association between hypercholesterolemia (levels >200 mg/dl) and increasing severity of stage of MGD.
The number of MGD patients with HDL <40 mg/dl and >40 mg/dl in our study was 17 (56.66%) and 13 (43.33%), respectively. Majority of patients with HDL 40 mg/dl belonged to Stage 2, whereas a minimum number of patients with HDL >40 mg/dl also belonged to Stage 2. As the P value was = 0.39, it does not establish a correlation between the two and was found to be insignificant and so was the relation of MGD with either of the sexes.
A study done by Gulani et al. also found a correlation of increasing age and higher stages of MGD.
A study done by Dao et al. also could not detect any significant correlation between MGD and elevated or low level of HDL. Their study also establishes a prevalence of dyslipidemia in MGD patients. It is mainly correlated with cholesterol and TGs. However, they could not establish a correlation between the level of LDL and MGD. This can be explained due to large difference in the sample size of the two studies.
A study done by Bhkhari et al. concludes that the disease severity of MGD is more with higher level of TGs and LDL, and a positive correlation was found for female sex. This discrepancy can be explained by two facts: large difference in the number of patients involved and less number of females in higher age group. Studies with larger populations are needed to prove whether this association is indeed causal. Treatment aimed at correcting hyperlipidemia may also improve the clinical features of MGD.,,,,,
| Conclusions|| |
Higher stages of MGD are associated with increased age. MGD and increasing levels of LDL, total cholesterol, and triglycerides have a positive correlation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]