Congenital distichiasis is a rare condition in which accessory row of lashes is present in place of the Meibomian gland orifice. These aberrent ciliae irritate the cornea and conjunctiva and therefore cause epiphora, photophobia, conjunctival injection, corneal erosions, and may develop into opacification. All four patients from the same family who had anomalous row of lashes in their eyelids complained of the same persistent ocular irritation along with strabismus and ptosis. We performed, on all of the four patients, lid splitting along the gray line and cryotherapy to the posterior lid lamella where the follicles of aberrent ciliae are located, and excised redundant skin of upper and lower lids. By these operations, all four patients showed improvement in their ocular irritaton. We report clinical presentation of four patien~s of congenital distichiasis and believe lid splitting and cryosurgery is effective method for congenital disti chiasis.
Cilia ; Conjunctiva ; Cornea ; Cryosurgery* ; Cryotherapy ; Eyelids ; Humans ; Lacrimal Apparatus Diseases ; Meibomian Glands ; Photophobia ; Skin ; Strabismus

Objective: This study determined the most common normal lid-margin and conjunctival bacterial flora, antibiotic sensitivity, and resistance patterns in eyes of Filipinos scheduled for routine cataract surgery at a tertiary government hospital. Methods: Lid-margin and conjunctival swab specimens were collected from patients scheduled to undergo routine cataract-extraction surgery at the Department of Ophthalmology and Visual Sciences of the University of the Philippines– Philippine General Hospital. The specimens were cultured using standard technique and those with bacterial growth were tested for antibiotic sensitivity and resistance using the disc-diffusion method. Results: Sixty eyes of 30 patients were sampled, 17 females (57%) and 13 males (43%), with a mean age of 61.4 12.5 years (range, 37 to 84). Of the 30 patients swabbed, 27 (90%) were culture positive. The most common organism identified was Staphylococcus epidermidis (24/27, 89%). Bacillus sp. was identified in 12 (44%) patients. Staphylococcus aureus was identified in 3 (12%) patients. Results of antibiotic sensitivity testing revealed that 85% or more of the coagulase-negative staphylococcus isolates were sensitive to moxifloxacin, gatifloxacin, ciprofloxacin, vancomycin, gentamycin, tobramycin, and chloramphenicol. Conclusions Staphylococcus epidermidis was the most frequently isolated organism in the eyelid margin and conjunctiva of patients for routine cataract surgery. The isolates showed high sensitivity to commonly prescribed topical antibiotic preparations.
Eyelids ; Conjunctiva

PURPOSE: To report a case of corneal opacity improved by treatment of demodex blepharitis. CASE SUMMARY: A 50-year-old female who received sub-laser-assisted in situ keratomileusis (LASIK) flap surgery was referred to our clinic with corneal opacity and neovascularization in her left eye. Her visual acuity was 0.5. Telangiectasis of the eyelid margin and meibomian gland dysfunction were observed. Seven Demodex folliculorum were found in 4 eyelashes of the left eye. Lid scrub with 0.4% polyhexamethylene biguanide (PHMB) and ointment containing dexamethasone was started for demodex blepharitis treatment. After 6 months of treatment, the number of Demodex folliculorum was decreased to 2 and the best corrected visual acuity was 0.8. Corneal opacity and neovascularization were also improved. CONCLUSIONS: The present study showed that demodex blepharitis can induce atypical corneal opacity and neovascularization after LASIK surgery. Evaluation and treatment of demodex blepharitis in these patients is important.
Blepharitis* ; Corneal Neovascularization ; Corneal Opacity* ; Dexamethasone ; Eyelashes ; Eyelids ; Female ; Humans ; Keratomileusis, Laser In Situ ; Meibomian Glands ; Middle Aged ; Telangiectasis ; Visual Acuity

Sebaceous carcinoma is a rare malignant appendageal tumor of the skin and is usually located on the meibomian glands if the eyelid. We present a case of sebaceous carcinoma developed in a scapulir area. A 77-year old male had been suffering from a 3x2.5 cm sized ulcerated mass with an indurated margin an the left scapular area for 10 years. Histopathologirally, irregular, lobular formations were composed of sebaceous and undifferentiated cells showing considerable variation in the shape and size of their nuclei. We removed the lesion by surgical excision and could not find any recurrence for 30 months.
Aged ; Eyelids ; Humans ; Male ; Meibomian Glands ; Recurrence ; Skin ; Ulcer

PURPOSE: To examine the changes in meibomian glands associated with aging in a normal Korean population and to estimate the differences between the upper and lower eyelid in each age group. METHODS: We performed meibography on adult subjects using an infrared charge-coupled device (CCD) camera. Each eyelid was scored based on the loss of meibomian glands, and the meiboscores of the upper and lower eyelids were summed to obtain a score for each eye. Meiboscores were evaluated according to age, sex, and upper and lower eyelid meiboscores in each age group. RESULTS: One hundred seventeen eyes of 117 people were enrolled in this study. The study subjects had an average age of 50.4 +/- 19.1 years (range, 20-92; male, 56; female, 61). There was a significant positive correlation between age and total meiboscore, upper and lower eyelid meiboscore (r = 0.578, p < 0.001; r = 0.550, p < 0.001; r = 0.524, p < 0.001). There were no significant differences in the meiboscores of the upper and lower eyelids in any age group, though meiboscores were significantly higher since 40 year-old group than 20 year-old group (p < 0.001, p < 0.001, p < 0.001, p < 0.001). CONCLUSIONS: Based on noncontact meibography in normal adult eyes, the authors concluded that prevalence of changes in the meibomian glands was about 60% and changes in meibomian glands increase with age.
Adult ; Aging ; Eyelids ; Female ; Humans ; Male ; Meibomian Glands* ; Prevalence

The meibomian gland adenocarcinoma is very rare and lethal tumor of the eyelid. The upper eyelid is more often affected than the lower eyelid. Clinical feature of this tumor is that it may masquerade as a chalazion or chronic blepharoconjunctivitis for many months before the true diagnosis is established. Treatment of the consists of surgical removal and radiation therapy. The authors have experienced a case of meibomian gland adenocarcinoma which had recurred after two chalazion surgeries at a local clinic in the left lower eyelid of a 61-year-old korean female. The tumor was excised surgically with reconstruction of the lid defect by modified Hughes procedure and was found to be a adenocarcinoma of the meibomian gland histopathologically.
Adenocarcinoma* ; Chalazion ; Diagnosis ; Eyelids ; Female ; Humans ; Meibomian Glands* ; Middle Aged

PURPOSE: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface.METHODS: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView® (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed.RESULTS: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = −0.560, p = 0.024; r(s) = −0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022).CONCLUSIONS: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.
Dry Eye Syndromes ; Eyelids ; Meibomian Glands ; Retrospective Studies ; Tears

PURPOSE: We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea. METHODS: One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded. RESULTS: The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, p < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid. CONCLUSIONS: The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.
Classification ; Diagnosis ; Eyelids ; Humans ; Hygiene ; Korea ; Meibomian Glands

PURPOSE: To evaluate the correlation between the ocular surface disease index (OSDI score) and objectively quantifiable parameters in dry eye syndrome patients, and to assess environmental and lifestyle risk factors in severe OSDI patients. METHODS: The present study was retrograde and included 30 patients (30 eyes) diagnosed with dry eye syndrome at Ilsan Paik Hospital for the first time. Shirmer's test, corneal staining, and conjunctiva staining were assessed, and tear break-up time, meibum quality, and OSDI questionnaires were performed. We measured the lipid layer thickness in tear meniscus and counted the amount of partial eyelid blinking using Lipiview®. Moreover, we modified images of the lower lid meibography and calculated the percentage of meibomian glands outside the lower tarsal plate using the ImageJ® software. We analyzed the Pearson's correlation and performed a multiple linear regression analysis between the test values and OSDI. In addition, logistic regression analysis was used to determine the risk factors of the severe OSDI group, such as insomnia, level of computer use, and exposure to fully air-conditioned indoor environments. RESULTS: According to the Pearson's correlation analysis, quality of the meibum showed the highest statistically significant correlation with OSDI, followed by age, conjunctiva staining score, counts of partial blinking, and corneal staining score. The multiple linear regression analysis revealed that quality of the meibum and age were statistically significant factors affecting the OSDI score. Based on the logistic regression analysis, using a computer for more than 4 hours at a time exhibited a 7.43-fold odds ratio for severe OSDI (p-value = 0.029). CONCLUSIONS: Meibomian gland dysfunction and age should be considered to be important factors, especially in treating dry eye syndrome patients who complain severely. Moreover, we should also consider environmental factors such as long-term computer use for the treatment of dry eye syndrome patients with severe symptoms.
Blinking ; Conjunctiva ; Dry Eye Syndromes* ; Eyelids ; Humans ; Life Style ; Linear Models ; Logistic Models ; Meibomian Glands ; Odds Ratio ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Tears

Dry eye syndrome is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms. Tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Symptom screening with the Five-item Dry Eye Questionnaire or Ocular Surface Disease Index can be used to identify the possibility that a patient might have DED dry eye syndrome and triggers. The results of these screening tools can lead to performing diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and assessments of the volume and severity of tear allow the subclassification of dry eye syndrome as predominantly evaporative or aqueous deficient, which informs the management of dry eye syndrome. A staged management algorithm was derived that presents a stepwise approach to implementing the various management and therapeutic options according to disease severity.
Conjunctiva ; Cornea ; Diagnosis ; Diagnostic Tests, Routine ; Dry Eye Syndromes ; Eyelids ; Fluorescein ; Homeostasis ; Humans ; Inflammation ; Mass Screening ; Meibomian Glands ; Osmolar Concentration ; Tears