Purpose: To observe (1) changes in meibomian gland (MG) after exposure to intense pulsed light (IPL) and (2) to understand the mechanism by which IPL treats meibomian gland dysfunction (MGD) in patients. Methods: A cohort study, including 35 MGD patients, was conducted. IPL treatment was administered in one group (IPL group; n = 18), and eyelid hygiene in another (control group; n = 17) for 3 months. All patients were given artificial tears during the treatment period. Associated ocular-surface indexes (ocular surface disease index, OSDI; tear breakup time, TBUT, Schirmer 1Test, corneal staining, and conjunctival staining), MG function, MG macro-morphology, and MG micro-morphology were examined before and after treatment. The relationships between the change in symptom score and the change in the other indexes (related ocular-surface indexes, MG functional indexes, and MG morphological indexes) were evaluated. Results: There was no statistical difference in pretreatment between the IPL and the control groups in terms of age, gender, related medical history, MGD stage, and all examined indexes, with the exception of conjunctival staining. OSDI, TBUT, meibum quality, MG expressibility, and MG dropout improved after treatment in both of the two groups (all P < 0.05). The MG microstructure indexes, including the MG acinar longest diameter (ALD), MG acinar unit density (AUD), and the positive rate of inflammatory cells (ICs) around glandular structures were significantly improved in the IPL group. No improvements of microstructure were found in the control group. Conclusion: IPL treatment improves the symptom score of patients, associated ocular-surface indexes, MG function, and MG macrostructure as well as eyelid hygiene. And IPL treatment particularly improves MG microstructure and decreases MG inflammation in MGD patients.

Purpose: To observe reversibility of meibomian gland (MG) dropout and analyze correlated factors and to compare the treatment efficiency with and without eyelid hygiene in patients with meibomian gland dysfunction (MGD). Methods: Consecutive 78 eyes of 78 MGD (stage 2–3) patients who finished follow-up examination after 1-month of treatment were recruited in this retrospective study. All patients were treated with artificial lubricant and eyelid hygiene. Related ocular surface evaluation and meibomian gland assessment were examined. Results: There were 26 (33%) patients (included in group 1) who ignored doctors' order for eyelid hygiene, and 52 (67%) patients (included in group 2) were compliant. There was no statistical difference between group 1 (age, 44.4 ± 12.2) and group 2 (age, 38.9 ± 16.6) in characteristics and pretreatment clinical indexes. However, after 1-month of treatment, only the ocular surface disease index of group 1 improved (P = 0.048), whereas all clinical indexes of group 2, except the Schirmer test result, improved (including expressibility, all P < 0.05). A 5% decrease in MG dropout of both upper (5.4%) and lower (4.6%) eyelids in group 2 was observed. Improvement in upper-eyelid dropout and expressibility were the predictors of lower-eyelid dropout improvement. The reversibility had no correlation with age, sex, pretreatment MGD stage, disease duration, and use of topical antiinflammation medication. Conclusions: With expressibility-improving treatment, MG dropout was reversible to some extent. Eyelid hygiene is an efficient treatment of MGD; however, there is a need for ophthalmologists to instruct patients on conduct and supervise patients' compliance.

To evaluate the distribution of meibomian gland dropout and analyze the correlation between dropout and meibomian gland dysfunction (MGD). A total of 161 eyes of 85 patients with MGD were recruited as the MGD group; 88 eyes of 46 health volunteers were enrolled as the control group (2:1 matched for age and sex). Examinations included the Schirmer I test, breakup time, symptom questionnaire, corneal fluorescein staining, meibum quality, meibomian gland expressibility, and meibomian gland dropout. (1) The incidences of chalazion and eyelid surgery were significantly higher in patients with MGD. (2) All clinical indexes were better in healthy volunteers (all P < 0.05). (3) The dropout in the upper eyelid was statistically lower (P < 0.01) in both groups. The nasal and/or temporal part had higher dropout than did the middle part, except in the lower eyelid of the control group. (4) The entire or partial dropout was positively related to MGD occurrence. Both additive dropout of the entire 2 eyelids and that of the 2 nasal parts had the strongest correlation (r = 0.792, P < 0.01). (5) In the MGD group, breakup time was most negatively related to upper nasal dropout (r = -0.229, P < 0.05). The corneal staining score was positively related only to the dropout of additive (r = 0.185, P < 0.05) and lower (r = 0.258, P < 0.05) middle parts. (1) Uneven dropouts exist in different or single eyelids. (2) Dropout evaluation is better when covering the entire area of both upper and lower meibomians. (3) Nasal part dropout plays a more essential role than the other dropouts in MGD occurrence.