The role of lid margin structures in the meibomian gland function and ocular surface health

ABSTRACT

Introduction

The lid margins are essential to maintain a healthy tear film and distribute it over the ocular surface to achieve an optimal refractive interface. Alterations in the lid margin structures and function may lead to significant ocular surface problems. Meibomian gland dysfunction is usually attributed to be the most common reason for ocular surface disease. However, the lid margin disease cannot be fully understood and adequately addressed if the function of the meibomian glands is not evaluated in relation to other lid margin structures.

Areas covered

This review aims to emphasize that the lid margin requires a full assessment in order to address ocular surface diseases associated with lid margin disease. The different zones of the lid margin and their roles in the maintenance of ocular surface health are delineated. Alterations in the lid margin structures due to increasing age or underlying etiology and their potential impact are discussed.

Expert commentary

If structural abnormalities are not recognized and properly addressed, the treatment of meibomian gland dysfunction will likely fail. Future studies focusing on the underlying etiology of structural alterations will hopefully lead to the development of more effective therapeutic options.

KEYWORDS:

• Dry eye
• floppy eyelid
• lash ptosis
• lid margin
• marx’s line
• meibomian gland
• mucocutaneous junction
• ocular surface disease
• tear meniscus

Article Highlights

• Meibomian gland health should be assessed in relation to the other lid margin structures.

• The assessment of blinking pattern, lid position, lid laxity, and conjunctivochalasis should be included in the lid margin disease workup.

• Vital dyes are not only used to assess ocular surface staining but also to assess conjunctival folds, Marx’s line, and lid wiper epitheliopathy.

• Recognition of age-appropriate changes is crucial to differentiate them from pathological changes.

• Lid margin changes beyond the expected level in older patients should warrant further investigation for underlying pathology.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper is not funded