Meibomian inversion syndrome and the cornea

Session Details

Session Title: Presented Poster Session: Medical Cornea

Venue: Poster Village: Pod 3

First Author: : E.Samia-Aly UK

Co Author(s): :    P. Mehta   A. Barua                    

Abstract Details

Purpose:

We describe the diagnosis and management Meibomian Inversion Syndrome (MIS)- chronic lid margin disease changing the anatomy of the lid wiper region of the upper lid. This condition is often misdiagnosed as dry eye or superior limbic keratoconjunctivitis due to symptoms of irritation, excessive blinking and dry eye symptoms with poor tear film stability. However, there is superior corneal, limbic and conjunctival staining from chronic upper lid wiper damage which results in progression from ocular surface staining to epitheliopathy which can cause corneal scarring. We report on our experience of 7 patients treated for this condition, prior to cataract surgery.

Setting:

Affected patients who attended the corneal clinic in a UK teaching hospital were diagnosed MIS. All patients were seen and diagnosed by the corneal specialist and after conservative management were referred for an oculoplastic opinion. All patients were seen and managed in the same UK ophthalmic unit.

Methods:

5 patients (7 eyes) were diagnosed with MIS and included in the case series with data between July 2017 and February 2019. All were female and age range from 58 to 82. All diagnosed with blepharitis and lid wiper epitheliopathy (super corneal and limbic staining). 3/7 eyes had clinically significant corneal scarring, 1 patient had Sjogren's. All patients complained of soreness, burning and 2 described blurred vision and 1 described severe photophobia. 4/5 patients started doxycycline and all had lipid-replacement drops and sodium hyaluronate drops. 3 eyes were on steroid drops and ciclosporin 0.1% drops. 3 eyes had coexistent ptosis.

Results:

All patients underwent upper lid everting sutures using 6-0 vicryl. At 2 weeks post surgery, 6 eyes (85%) had symptomatic improvement, 1 (15%) no change. 7 (100%) eyes had improvement on examination of the ocular surface. At 3 months follow-up so far data for 4 eyes available shows improvement in both appearance and examination. All patients showed stability or improvement in vision, except for 1 patient who was planned for cataract surgery after eyelid surgery combined with epithelial debridement and amniotic membrane. The vision improved following cataract surgery. Others with corneal scarring improved without further surgery.

Conclusions:

MIS can create very distinctive symptoms of constant soreness, grittiness and pain/photophobia with specific clinical patterns despite maximal topical treatment. The irregular/ dysfunctional lid wiper mechanism with inversion of the meibomian glands results in constant irritation of the superior corneal and limbal area. Conservative measures may help and bandage contact lens trial may relieve symptoms. This case series shows the remarkable improvement with a relatively simple oculoplastic procedure alleviating corneal scarring or halting the symptoms mistaken for dry eye. Ocular surface disease needs to be co-managed prior to further corneal/refractive/cataract surgery as this may affect the outcome and measurements.

Financial Disclosure:

None