Purpose: To study the epidemiology of meibomian gland (MG) dysfunction in an elderly, predominantly male population. Methods: Prospective study of 233 subjects seen in the Miami Veterans Affairs eye clinic. Patients underwent a complete ocular surface examination, including dry eye questionnaires and tear assessments (osmolarity, tear breakup time, corneal staining, Schirmer test). The main outcome measures were correlations between MG parameters and demographics, dry eye symptoms, and tear parameters. The studied MG parameters were eyelid vascularity and meibum quality; a score ≥2 for either parameter was considered abnormal. Results: Mean age of the 233 subjects was 63 years (SD = 11); 91% were male and 59% had at least 1 abnormal MG parameter (abnormal quality 55%; vascularity 17%). Demographically, patients with abnormal MG parameters were significantly older than their counterparts without these findings. Whites were more likely to have abnormal eyelid vascularity compared with blacks [n = 36 (31%) vs. n = 1 (1%), P < 0.0005] but no differences were noted between races with respect to meibum quality. Abnormal meibum quality, but not abnormal vascularity, was significantly associated with more severe dry eye symptoms. Similarly, abnormal meibum quality, but not eyelid vascularity, was significantly associated with worse dry eye signs, including decreased tear breakup time and increased corneal staining (P < 0.05 for all). Conclusions: MG dysfunction is a frequent finding in an elderly, predominantly male population with racial differences noted in the frequency of abnormal eyelid vascularity but not in MG quality. Abnormal meibum quality was significantly associated with more severe dry eye symptoms and signs.

To evaluate technologies and techniques available for the diagnosis of ocular surface tumors. A review of the literature from 1947 to 2017, through the PubMed Database, was conducted in order to evaluate current diagnostic methods for ocular surface tumors. Ocular surface squamous neoplasia, conjunctival melanoma, and conjunctival lymphoma are the three most common ocular surface malignancies. Technologies available to assist with diagnosis of these conditions, in addition to full thickness biopsy, include vital dyes, aspiration and impression cytology, in vivo confocal microscopy, ultrasound biomicroscopy, genetic testing, and anterior segment optical coherence tomography. Histology remains the gold standard for diagnosis for all 3 of these malignancies. However, multiple diagnostic techniques are available to assist in making preliminary and early diagnoses, in differentiating between similar-appearing lesions, and in some cases, avoiding biopsy prior to initiating treatment. As imaging and technology continue to evolve, these adjunctive techniques will likely continue to play a greater role in clinical practice.

Conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia (BRLH) are conditions that often have a similar appearance on the ocular surface. The use of high resolution anterior segment optical coherence tomography (HR-OCT) enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions. In this study, we characterize the morphological differences seen in conjunctival lymphoma, conjunctival amyloidosis and BRLH on HR-OCT imaging. A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma, conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute. Patients were excluded if HR-OCT imaging was not performed on initial presentation. Thirty-four total eyes of 27 patients were identified. Twenty eyes had conjunctival lymphoma (16 patients), 8 eyes had conjunctival amyloidosis (6 patients) and 6 eyes had BRLH (5 patients). All conditions appeared clinically as pink, red or yellow subepithelial lesions but had different features on HR-OCT. In lymphoma, HR-OCT images typically showed homogenous, dark subepithelial lesions with smooth borders, containing monomorphic dot-like infiltrates. HR-OCT images of amyloidosis typically showed heterogeneous, dark lesions with irregular borders, often containing hyperreflective linear infiltrates. HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue, at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective, subepithelial tissue. Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions. Distinctive features on HR-OCT of conjunctival lymphoma, conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination. Future studies can further validate this technology’s use with more subtle and challenging lesions.