Analysis of Factors Associated with Anterior Location of Marx’s Line

Abstract

Purpose

The study aimed to investigate the factors associated with anterior location of Marx’s line in ocular surface and living habits, especially in tear film.

Materials and methods

This cross-sectional study enlisted 483 participants with meibomian gland dysfunction, who were divided into two groups: 160 participants with mild anterior location of Marx’s line and 323 participants with moderate-to-severe anterior location. Participants completed a survey of demographic characteristics (sex, age, length of visual terminal use, sleep duration, skin property), and the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires. They also underwent slit-lamp examinations of the lids, and measurements of non-invasive tear break up time, tear meniscus height, fluorescein tear break up time, lipid layer thickness, partial blink rate, lid wiper epitheliopathy, and meibomian gland dropout.

Results

The tear meniscus height (mild:0.21(0.18–0.25), moderate-to-severe:0.19(0.16–0.23), p = 0.004), fluorescein tear break up time(mild:3(2–4),moderate to severe:2(1–3), p = 0.000), max LLT(mild:87(62–100), moderate-to-severe:99(69–100), p = 0.04), average LLT(mild:64.5(47.5–96.75), moderate-to-severe:74(53–100), p = 0.012), min LLT(mild:52(38–75), moderate-to-severe:59(41–85), p = 0.029) differed significantly between mild and moderate-to-severe anterior location of Marx’s line, and associated to the anterior location of Marx’s line(r=-0.134, p = 0.03; r=-0.194, p = 0.000; r = 0.093, p = 0.041; r = 0.119, p = 0.009; r = 0.105, p = 0.022) However, no statistical significance was observed in the OSDI, SPEED, partial blink rate, non-invasive tear breakup time, lipid layer thickness, meibomian gland dropout and lid wiper epitheliopathy(p > 0.05). Meanwhile, in the demographic characteristics, statistically significant correlations were associated with skin property(r = 0.154, p = 0.001) and sleep duration(r=-0.124, p = 0.006), but not with age, sex, and the length of visual terminal use (p > 0.05).

Conclusions

Lower TMH and shorter TBUT positively correlated with anterior location of the Marx’s line, and were risk factors. Meanwhile, participants with oily skin and shorter sleep duration were more likely to exhibit anterior location of Marx’s line.

Keywords:

• Marx’s line
• meibomian gland dysfunction
• risk factors
• tears

Acknowledgements

We thank all of the participants recruited for this study. We would like to thank Editage (www.editage.cn) for English language editing.

Disclosure statement

The authors have no commercial or proprietary interest in any concept or product described in this article.

Ethics statement

The studies involving human participants were reviewed and approved by the Medical Ethics Committee of Tianjin Medical University Eye Hospital (No:2021KY(L)-17). The participants/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Additional information

Funding

This study was funded by the Tianjin Health Research Project (TJWJ2023ZD002) and Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-037A).