Sex Differences in the Prevalence of Meibomian Gland Dysfunction: A Mini Review

Figures & data

Figure 1. Flow chart of the search strategy.

Figure 2. Locations of included prevalence studies.

Table 1. Population-based studies.

Population-based studies
Authors (year) journal	Country	Population		N (W:M)	Age	Diagnostic criteria for MGD	MGD, % (n)	MGD women, % (n)	MGD men, % (n)	Difference P-value
Aapola et al. (2022) Acta Ophthalmol.^40	Finland	All 1508 inhabitants of a rural area of Finland were initially invited. 601 attended the ophthalmic examination at the 22-year follow-up visit.	Population-based, cross-sectional assessment as part of a larger cohort study.	601 (335:266)	72.1 y (62–86)	Efron scale (0–4) with threshold for diagnosis ≥2	16% (93)	13%	18%	< 0.001
Hashemi et al. (2021) Int Ophthalmol.^34	Iran	Random sample of inhabitants >60 y from Tehran	Population-based, cross-sectional study.	3310 (1889:1421)	68.2 y (60–97)	Defined as MGD stage ≥2: Stage 2: Minimal to mild symptoms, no or limited corneal staining, and MQ and ME are mildly altered.	71.2%	65.9%	76.5%	< 0.001
Gao et al. (2020) Int J Opthalmol.^35	China	Staffs and faculty of Sichuan University as part of annual physical examination	Retrospective analysis	4404 (2199:2205)	43.0 y (19–85)	Viscous, waxy white, or no secretion with moderate pressure to the middle part of the upper eyelid by cotton swab, presence of lid margin telangiectasia, plugging of meibomian gland orifice, and irregular lid margin.	32.3% (1424)	32.7% (718)	32.0% (706)	0.3
Craig et al. (2020) Ocul Surf.^41	New Zealand	Participants in a representative birth cohort in Dunedin.	Population-based, cross-sectional assessment as part of a larger cohort study.	885 (442:443)	All participants were 45 y	Diagnosis of dry eye disease (SANDE score ≥30, and Non-invasive tear film breakup time <10s) and tear film lipid layer grade ≤3, or meibography grade >1	7% (65)	9% (41)	5% (24)	0.03
Arita et al. (2019) Am J Ophthalmol.^11	Japan	All 616 inhabitants >6 y of Takushima Island were invited.	Population-based, cross-sectional study	356 (223:133)	55.5 y (6–96)	1) the presence of any chronic ocular symptom; 2) >1 lid margin abnormality (vascularity, displacement of the mucocutaneous junction (MCJ), and irregularity), and 3) Altered ME in at least 1 eye).	32.9% (117)	27.4% (61)	42.1% (56)	0.0051
Hashemi et al. (2017) Cont Lens Anterior Eye^33	Iran	Random sample of the 28.000 adult residents of Shahroud.	Population-based, cross-sectional assessment as part of a larger cohort study.	4700 (2769:1931)	55.9 y (40–64)	Diagnosis according to The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. All subtypes were considered as MGD. MGD cases included both hypersecretory and hyposecretory types and the cases with Meibomian gland diseases excluded from MGD definition.	26.3% (1235)	25.2% (698)	27.8% (537)	No significant sex difference
Viso et al. (2012) IOVS^37	Spain	Random sample of inhabitants >40 y in the O Salnés area. Of 1155 people invited, 619 agreed to participate, all of whom were Spanish whites.	Population-based, cross-sectional study	619 (390:229)	63.4 y (40–96)	One or more of the following: (1) absent, viscous or waxy white secretion upon digital expression, (2) presence of two or more lid margin telangiectases, and (3) plugging of two or more gland orifices.	69.5% (141)	66.1% (76)	73.9% (65)	0.003
Siak et al. (2012) Cornea^42	Singapore	Random sample of the Malay population in Singapore. Of 4168 people invited, 3280 agreed to participate.	Population-based, cross-sectional study	3271 (1694:1577)	58.7 y (40–79)	Presence of either lid margin telangiectasia or meibomian gland orifice plugging in at least one eye of each participant.	57.2% (1871)	52.1% (884)	62.7% (987)	< 0.001
Viso et al. (2011) Cornea ^36	Spain	Random sample of inhabitants >40 y in the O Salnés area. Of 1155 people invited, 654 agreed to participate, all of whom were Spanish whites.	Population-based, cross-sectional study	654 (411:243)	63.6 y (40–96)	Viscous or waxy secretion or no secretion at all upon digital expression, lid margin telangiectasia, or plugging of the meibomian gland orifices	30.5%	27.5%	35.3%	Not available
Lin et al. (2003) Ophthalmology ^43	Taiwan	Random sample of inhabitants >65 y in the Shihpai community. Of the 2045 people invited, 1361 participated.	Population-based, cross-sectional study	1361 (539:822)	72.2 y (65–91)	Abnormalities of the meibomian gland, such as plugging and lid margin telangiectasia.	60.8% (828)	57.9% (312)	62.8 % (516)	0.071

ME: meibum expressibility; MQ: meibum quality; MG: meibomian gland; SANDE: symptom assessment in dry eye

Table 2. Hospital-based studies.

Hospital-based studies
Authors (year) journal	Country	Population	Study design	N (W:M)	Age, mean (range)	Diagnostic criteria for MGD	MGD all, % (n)	MGD women, % (n)	MGD men, % (n)	Difference P-value
Singh et al. (2022) Cureus^17	India	Patients with dry eye symptoms at a tertiary care center in South India.	Prospective study	250 (112:138)	45.3 y (18–83)	Minimally-to-marked altered quality of expressed meibum from scattered glands, minor-to-severe gland loss	40% (100)	37.5% (42)	42% (58)	0.5
Yadav et al. (2022) Indian J Ophthalmol.^16	India	Patients attending the outpatient department of a tertiary eye care hospital.	Cross-sectional study.	113 (51:62)	41.6 y (17–65)	A score of 1 or more for both MQ and ME or a score of >1 for either MQ or ME in at least one eye.	57.5% (65)	56.9% (37)	58% (36)	0.9
Abu et al. (2022) Afr Health Sci.^19	Ghana	Patients with type 2 diabetes at a specialist diabetes clinic.	Cross-sectional study	311 (240:71)	59.9 y (38–85)	A score of 1 or more for both MQ and ME in at least one eye.	55.3 % (172)	Not presented	Not presented	0.3
Badian et al. (2021) Sci Rep.^29	Norway	Patients with dry eye symptoms visiting a specialized ocular surface clinic.	Cross-sectional study	900 (668:232)	52 y, SD 16.7	A score of 1 for both MQ and ME or a score > 1 for either MQ or ME	93.8% (844)	94.6% (632)	91.4% (212)	No significant sex difference
Mussi et al. (2021) Clin Ophthalmol.^22	USA	Patients with a diagnosis of DED at a major urban outpatient medical center in Texas.	Retrospective case-control study	299 (215:84)	68. 3 y (24 − 97)	Altered quality of meibum, and/or decreased or absent expression, lid margin hyperemia, telangiectasis, and conjunctival hyperemia.	54.5%	50.7%	64.3%	0.046
Chatterjee et al. (2020) Cornea^17	India	Random sampling from new patients attending a corneal clinic at a tertiary eye care institute.	Cross-sectional study	570 (268:302)	49.3 y (20-84)	A score of 1 or more for both MQ and ME or a score of > 1 for either MQ or ME	55.6% (317)	63.2% (141)	50.4 % (176)	0.18
Robin et al. (2019) Transl Vis Sci Technol.^38	France	Patients at a national eye care hospital, followed for ocular surface diseases (OSD) including MGD, perennial allergic conjunctivitis, and Sjögren syndromes.	Retrospective study	226 (172:54)	54 y, SD 17	(1) alteration of the meibum expressibility, (2) altered MQ, or > 1 lid margin abnormality, and (3) absence of inflammatory skin disorders such as atopic dermatitis and rosacea.	40.3% (91)	37.8% (65)	48.1% (26)	0.086
Rathnakumar et al. (2018) J Basic Clin Physiol Pharmacol.^18	India	Patients with a diagnosis of DED at an ophthalmology outpatient department in South India.	Cross-sectional study	60 (37:23)	25–70 y	Dry eye patients were evaluated by slit lamp biomicroscopy for blepharitis and the degree of MGD.	66.7% (40)	75.7% (28)	52.2% (12)	0.032
Rabensteiner et al. (2018) Acta Ophthalmologica^39	Austria	Patients with dry eye at a dry eye unit of the ophthalmological department, Medical University of Graz.	Retrospective study	1372 (978:394)	55.4 y, SD 16.6	Reduced expressibility and/or quality of the meibum, as well as morphological changes of the lid margins, such as telangiectasia, irregularity and a shifting of the openings of the meibomian glands.	43.6% (598)	43.1% (422)	44.7% (176)	Not available
Asiedu et al. (2018) Optom Vis Sci^20	Ghana	Patients visiting the University of Cape Coast optometry clinic.	Cross-sectional study	212 (107:105)	21.9 y (17–40)	A score of 1 or more for both MQ and ME in at least one eye with or without lid margin abnormalities.	25.5%	28% (30)	22.9% (24)	0.4
Amano et al. (2017) IOVS^9	Japan	Patients scheduled for cataract surgery at an eye hospital in Tokyo.	Cross-sectional study	510 (305:205)	71.1 y (50–93)	One or more of the following signs present at least in one eye: viscous or waxy white secretion upon digital expression, presence of two or more lid margin telangiectases, and/or plugging of two or more gland orifices.	74.5% (380) adjusted	72.2% (226)	74.9% (154)	0.5
Amano et al. (2017) Cornea^10	Japan	Patients scheduled for cataract surgery at an eye hospital in Tokyo. (Same population as reported in Amano et al. (2017) above)	Cross-sectional study	510 (305:205)	71.1 y (50-93)	Both of the following factors present: abnormalities in the lid margin and signs of occlusion of the meibomian glands (reduced ME and plugging of 2 or more gland orifices).	47.5% (242)	Adjusted for age: 45.4% (150)	Adjusted for age: 42.5% (92)	0.5
Martinez et al. (2016) Clin Ophthalmol.^30	Mexico	New patients attending a tertiary care eye care center in Mexico City.	Cross-sectional study	338 (187:151)	45 y (16–85)	MQ ≥2	68 % (228)	62.6 % (117)	73.5 % (111)	OR =1.7, 95% CI 1.04–2.6
Hom et al. (1990) Optom Vis Sci^24	USA	Randomly selected patients coming for routine vision examinations at three Los Angeles area clinics.	Cross-sectional study	398 (198:200)	Not presented	Absent or inspissated meibomian gland secretion upon examination. (digital pressure against the lower lid margin under the lashes.)	38.9% (155)	41.9% (83)	36% (72)	No significant sex difference

ME: meibum expressibility; MQ: meibum quality, MG: meibomian gland

Figure 3. Chart over results from prevalence studies.

Figure 4. Decline of conjugated dihydrotestosterone metabolites in men and women (Redrawn figure based on results by Labrie et al.⁶²).

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Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.