How Clogged Meiboamian Oil Glands Are Related to Sjogren's
How Many People Have Sjogren's
Sjögren’s Syndrome (SS) affects approximately 3.1 million Americans and 430,000 Canadians in North America. Ninety percent of the Sjogrens population is female and the disease is characterized by infiltration of lymphocytes into exocrine glands, including sebaceous, sweat, salivary, and lacrimal glands.New Study - Sjogren's and MGD
Recent experiments have also reported that a common finding in patients with Sjogrens is androgen deficiency, which may lead to meibomian gland dysfunction (MGD).1,2,3 MGD is a common clinical condition and a major cause of lipid tear deficiency and evaporative dry eye.4 To date, very few studies have investigated the physical changes or secretions of the meibomian glands (MGs) in patients with Sjogrens.
This abstract5 focuses on a study that evaluated Meibomian loss (dropout) and lipid layer thickness in patients with and without Sjogrens. Eleven participants with Sjogrens (1M and 10F; mean age=56.0±9.1yrs) and 10 non dry eye (NDE) controls (3M and 7F; mean age=58.5±4.7yrs) were recruited. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire to assess dryness symptoms. Parameters evaluated include:
1. Non-invasive tear break up time (NITBUT)
2. Lipid layer thickness (LLT) was assessed by appearance using the Tearscope Plus (Keeler).
3. Meibomian Gland Imaging - The upper and lower lids of all subjects were everted and the MGs imaged using the infra-red (IR) camera of the Keratograph 4 (Oculus). Meibomian gland percentage drop-out score (MGDS) was obtained by digital analysis using ImageJ, which was based on the complete or partial gland loss observed in both lids. Subjective analysis (0-6 score) was also performed.
Results
The Sjogrens group recorded significantly higher Ocular Surface Disease Index scores, reduced Lipid Layer Thickness and lower Tear Breakup Time compared to controls. Percentage Meibomian Gland loss and subjective Meibomian Gland Drop Out Score was also significantly higher for the Sjogrens group.
Higher MGDS and reduced LLT and NITBUT may partly contribute to the severe ocular surface changes often observed in patients with SS. Meibography is a quick and easy assessment of the degree of MG drop-out. Digital grading via ImageJ may be time-consuming in a clinical setting, however, subjective methods for analyzing the physical loss of MGs is a good option and could aid in a better understanding and management of the disease.
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References
1. Sullivan, DA et al. Androgens and dry eye in Sjögren’s syndrome. Ann N Y Acad Sci. 1999;876:312-24.
2. Sullivan, DA et al. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci. 2002 Jun;966:211-22.
3. Sullivan, DA et al. Sex steroids, the meibomian gland and evaporative dry eye. Adv Exp Med Biol. 2002;506:389-99.
4. Craig JP, Tomlinson A. Importance of the lipid layer in human tear film stability and evaporation. Optom Vis Sci. 1997;74:8-13.
5. Menzies, KL et al. Infrared Imaging of Meibomian Glands and Evaluation of the Lipid Layer in Sjögren’s Syndrome Patients and Nondry Eye Controls. Invest Ophthalmol Vis Sci. 2015 Jan 8;56(2):836-41. doi: 10.1167/iovs.14-13864.
^ Back to top 2. Sullivan, DA et al. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci. 2002 Jun;966:211-22.
3. Sullivan, DA et al. Sex steroids, the meibomian gland and evaporative dry eye. Adv Exp Med Biol. 2002;506:389-99.
4. Craig JP, Tomlinson A. Importance of the lipid layer in human tear film stability and evaporation. Optom Vis Sci. 1997;74:8-13.
5. Menzies, KL et al. Infrared Imaging of Meibomian Glands and Evaluation of the Lipid Layer in Sjögren’s Syndrome Patients and Nondry Eye Controls. Invest Ophthalmol Vis Sci. 2015 Jan 8;56(2):836-41. doi: 10.1167/iovs.14-13864.
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