Comparative Analysis of Tear Film Parameters in Patients With and Without Meibomian Gland Dysfunction: A Prospective Observational Study

Abstract

Background: Meibomian gland dysfunction (MGD) is recognized as the leading cause of evaporative dry eye disease and contributes significantly to tear film instability and ocular surface inflammation. Alterations in tear film parameters such as tear break-up time (TBUT), Schirmer’s test values, Ocular Surface Disease Index (OSDI), lower tear meniscus height, and meibography findings are frequently observed in patients with MGD. Comparative assessment of these parameters in patients with and without MGD is essential for understanding disease severity and optimizing management strategies.
Aim: To compare tear film parameters between patients with and without meibomian gland dysfunction.
Materials and Methods: This prospective observational study was conducted in the Department of Ophthalmology, SCB Medical College and Hospital, Cuttack, Odisha, over a period of 1.5 years from September 2022 to May 2024. A total of 269 patients presenting with symptoms suggestive of dry eye disease were enrolled. Patients were divided into two groups according to meibomian gland status: MGD group (n=155) and Non-MGD group (n=114). Clinical evaluation included slit lamp examination, Schirmer’s test, tear break-up time, fluorescein staining, OSDI scoring, blink rate, blink interval, lower tear meniscus height, Marx line score, and meibography. Statistical analysis was performed using R version 4.3.2. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical variables were analyzed using Chi-square test. A p-value <0.05 was considered statistically significant.
Results: Patients with MGD demonstrated significantly lower TBUT values (8.12±2.11 s vs 11.89±1.84 s, p<0.001), lower Schirmer’s test scores (12.41±3.84 mm vs 16.93±3.17 mm, p<0.001), and reduced lower tear meniscus height (0.24±0.08 mm vs 0.36±0.10 mm, p<0.001). OSDI scores and Marx line scores were significantly higher among MGD patients (58.61±11.27 vs 41.48±9.36; p<0.001 and 1.87±1.02 vs 0.71±0.74; p<0.001 respectively). Meibography grades and fluorescein staining severity were also significantly associated with MGD.
Conclusion: Meibomian gland dysfunction is associated with significant deterioration of tear film parameters and increased symptom severity. Early diagnosis and intervention are essential to prevent progression of ocular surface disease and improve quality of life.