June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Association of Punctocanthal Epitheliopathy in Dry Eye Syndrome Secondary to Meibomian Gland Dysfunction
Author Affiliations & Notes
  • Jack V Greiner
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
    Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Paula Oliver
    Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, United States
    Clinical Eye Research of Boston, Winchester, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Jack Greiner, None; Paula Oliver, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1249. doi:
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    • Get Citation

      Jack V Greiner, Paula Oliver; Association of Punctocanthal Epitheliopathy in Dry Eye Syndrome Secondary to Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1249.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : This study extends our preliminary report describing an epitheliopathy of the often overlooked punctocanthal region (PCR) of the eyelid margins and further establishes its association with dry eye syndrome (DES) secondary to meibomian gland dysfunction (MGD). The PCR of the eyelid margins extends from the puncta to the nasal canthus.

Methods : Symptomatic dry eye patients (Group 1;n=100] had SPEED symptom scores of ≥6 and meibomian gland assessment (MGA) scores ≤12. The degree of MGD was measured according to methods previously described using a Meibomian Gland Evaluator to determine the secretory status of 15 meibomian glands of the lower eyelid (Greiner: Cur Eye Res 2012;37:272). Asymptomatic patients (Group 2;n=100) had SPEED scores <6 and MGA scores ≥20. Lid margins were stained with lissamine green (LG) and graded after 90s on a scale of 0-3. A grade of 0 indicated staining of the Line of Marx (LM) only and 3 indicated severe staining extending from the LM posteriorly in the sagittal plane up to >1.25 mm. Comparative grading was made on the temporal, central, and nasal lid margin over the tarsal plate as well as the lid margin over the PCR. Statistical analyses included Student's t-test with P <0.05 as significant.

Results : The PCR occupies up to 1/5 of the length of the lid margin and is slightly larger in the upper lid (UL) [P <0.05]. Punctocanthal epitheliopathy (PCE) was greater than the lid wiper epitheliopathy (LWE) over the temporal, central, and nasal tarsal regions in the UL and lower eyelids (LL) in both Groups 1 and 2 (P <0.001). The PCE staining was greater in the LL than in the UL in both Groups 1 and 2 (P <0.001) and there was greater staining in Group 1 (P <0.001).

Conclusions : PCE was greater in symptomatic dry eye patients with MGD than in asymptomatic patients with minimally detectable MGD. Although the PCE staining pattern resembles that of LWE, LG staining was greater in PCE. The PCR experiences inherently different lid mechanics than that of the conventional lid wiping action. The location and minimal motion of the PCR preclude PCE resulting from mechanical wiping of the lid margin as in LWE. PCE more likely results as a consequence of evaporation since this portion of the UL and LL margins may not undergo complete closure with blinking or sleeping. These observations support the hypothesis that PCE is a clinically relevant and readily observable marker of DES.

This is a 2021 ARVO Annual Meeting abstract.

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