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Jason Feuerman, Stephen Pflugfelder; Tear Meniscus Dimensions and Location of Marx’s Line in Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2013;54(15):925.
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In patients with tear film instability and meibomian gland dysfunction (MGD), Marx’s line (ML) is often displaced anteriorly. Bron, et al, suggest that ML may be formed as a result of a relatively increased solute concentration at the peripheral apex of the tear meniscus, which may thus play a significant role in the pathophysiology of primary MGD. We hypothesized that tear meniscus height, area, and length of anterior excursion along the lid margin positively correlate with the extent of anterior migration of ML in patients with MGD.
We performed a retrospective analysis of consecutive patients with eye irritation symptoms, MGD with tear film instability, no aqueous tear deficiency, and eyelid photographs and OCTs of sufficient quality for analysis. 32 eyes of 17 patients were included. Photographs of lissamine green-stained lower eyelids were analyzed using the ImageJ analysis software. The furthest anterior migration of ML was measured in 3 zones: temporal, central, and nasal. For each eye, the tear meniscus height, area, and length of anterior excursion at the center of the lower eyelid were measured using Fourier-Domain RTVue-100 optical coherence tomography (OCT). Spearman correlation analysis was performed.
The mean eye age was 68 ± 10 years. In the temporal zone, there was a statistically significant positive correlation between the furthest anterior migration of ML and the central tear meniscus height (r = 0.468, p = 0.007), area (r = 0.492, p = 0.004), and anterior excursion (r = 0.448, 0.010). In the central zone and the nasal zone there was no significant correlation between the furthest anterior migration of ML and any of the OCT measurements.
In patients with symptomatic MGD, central tear meniscus height, area, and anterior excursion positively correlate with the furthest anterior migration of ML in the temporal zone, but not in the central or nasal zone. A possible explanation is that aging changes such as conjunctivochalasis, which tends to be more pronounced temporally, physically impedes lateral tear migration leading to increased central tear pooling, while also promoting anterior excursion of the tear meniscus temporally by acting as a bridge. By this process, the solute gradient mechanism could contribute to the initiation of MGD. MGD could also just be initiated by increased exposure of meibomian gland orifices to tears, regardless of their osmolarity.
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