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Hua Zhu, Judith Flanagan, Nisha Yeotikar, Negar Babaei Omali, Daniel Tilia, Shamil Iskandar, Brien Holden, Eric Papas; Commensal microflora of eyelid margins and meibomian gland function in normal humans. Invest. Ophthalmol. Vis. Sci. 2013;54(15):926.
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The etiology of meibomian gland dysfunction remains unclear. The aim of our study was to assess the association between the commensal microflora of the eyelid margins and the function of the meibomian glands in different age groups of normal subjects.
103 subjects, aged from 25 to 65 years old, with no systematic conditions, pre-existing ocular irritation, injury or infection, were included in the study. An ocular swab was taken from the lower lid margin of the left eye of each subject. Conventional cultivation techniques were used for isolation and identification of microorganisms. Meibum quality (MQ) and meibomian gland expressibility (MGE) of the lower eyelid were graded following the guidelines of TFOS workshop on meibomian gland dysfunction. Meibography was performed on the lower eyelids using an infra-red camera, and meibomian gland loss factors (MGLF, degrees 0 to 4) were assessed. The association between microorganism counts and meibomian gland functional grading/s (including MQ, MGE, or MGLF) was assessed.
The most commonly identified microorganisms were commensal skin bacteria including Propionibacterium species (87%), and coagulase negative staphylococci, mainly Staphylococcus epidermidis (80%). A significantly higher number of microorganisms (348 ± 231 cfu per swab) was found on eyelid swabs collected from subjects with an MQ grade of 4 (no meibum expressed) and an MGE grade of 3 (no glands expressible) compared to the MQ grades 0-2 (< 157 ± 165 cfu per swab; p < 0.05) and MGE grades 0-2 (< 131 ± 134 cfu per swab; p < 0.01). The average number of microorganisms recovered from eyelid swabs was significantly lower in the younger (25 - 44 years old) female group (50 ± 69 cfu per swab) compared to the older (≥ 45 years age) female group (145 ± 170 cfu per swab, p < 0.05) and male group in general (191 ± 169 cfu per swab, p < 0.05). Concomitantly, more younger women (63%) than either older women (35%) or males (33%) presented with MQ grade 0 (p < 0.05).
Higher numbers of commensal bacteria on the eyelids are associated with clinical measures of decreased meibum quality and function, as well as increased age in female population. It remains unknown whether the increased number of bacteria is a causative agent to the compromise of meibomian gland function, or a consequence, either of such changes or other systemic factors, e.g. reduced sex hormones in elderly women.
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