Influence of eyelid pigmentation on the diagnosis of meibomian gland dysfunction

Abstract

Purpose

To determine whether reliance on eyelid margin vascularization as a diagnostic criterion for meibomian gland dysfunction (MGD) results in underdiagnosis of MGD in individuals with dark skin pigmentation.

Patients and Methods

This cross-sectional study enrolled consecutive cornea clinic patients in Buffalo, New York. Eyelid margin vascularization was graded qualitatively from slit-lamp photos. Skin pigmentation was quantified from digital photos using red/green/blue (RGB) pixel analysis and dichotomized using the RGB median. MGD was defined as abnormal quantity or quality of meibum or increased pressure required to express meibum. Additional testing included infrared meibography, Schirmer’s testing, and a dry eye questionnaire. Sensitivity of MGD diagnosis by visualization of vascularization, compared to diagnosis by expression of meibum, was estimated with and without stratification by skin pigmentation.

Results

Among 47 participants, 15–79 years old, meibomian gland truncation/dropout, abnormal tear production, and dry eye symptoms affected individuals of all skin pigmentations. Eyelid margin vascularization was less common in subjects with dark (n=21%) compared to light pigmentation (65%; p=0.002), although the prevalence of MGD assessed via clinical evaluation did not vary significantly between those groups. Use of eyelid margin vascularization alone was not sensitive (33%) for MGD diagnosis. The sensitivity was 17% when limited to those with dark pigmentation.

Conclusion

Our findings highlight the importance of gland expression and suggest limiting reliance on eyelid margin vascularization for MGD diagnosis, especially in those with dark eyelid skin pigmentation.

Keywords:

• meibomian glands
• dry eye syndromes
• skin pigmentation

Acknowledgments

Funding was provided by Jacobs School of Medicine and Biomedical Sciences, University at Buffalo Summer Research Fellowship (MJB); start-up funds from the Jacobs School of Medicine and Biomedical Sciences and Department of Ophthalmology, University at Buffalo (SPP).

This work was supported, in part, by facilities and resources provided by the VA Western New York Healthcare System. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.

Disclosure

Dr Sangita P Patel reports personal fees from Novartis, outside the submitted work. The authors report no other conflicts of interest in this work.