Exploratory Search for Characteristic Symptoms to Distinguish Meibomian Gland Dysfunction from Dry Eye in a Population-Based Study in Japan

Reiko Arita; Takanori Mizoguchi; Motoko Kawashima; Shima Fukuoka; Shizuka Koh; Rika Shirakawa; Takashi Suzuki; Naoyuki Morishige

doi:10.3390/jcm11061715

Exploratory Search for Characteristic Symptoms to Distinguish Meibomian Gland Dysfunction from Dry Eye in a Population-Based Study in Japan

J Clin Med. 2022 Mar 19;11(6):1715. doi: 10.3390/jcm11061715.

Authors

Reiko Arita^{1

2}, Takanori Mizoguchi^{1

3}, Motoko Kawashima^{1

4}, Shima Fukuoka^{1

5}, Shizuka Koh^{1

6}, Rika Shirakawa^{1

7}, Takashi Suzuki^{1

8}, Naoyuki Morishige^{1

9}

Affiliations

¹ Lid and Meibomian Gland Working Group, 626-11 Minami-Nakano, Minumaku, Saitama 337-0042, Japan.
² Department of Ophthalmology, Itoh Clinic, 626-11 Minami-Nakano, Minumaku, Saitama 337-0042, Japan.
³ Department of Ophthalmology, Mizoguchi Eye Clinic, 6-13 Tawaramachi, Sasebo 857-0016, Japan.
⁴ Department of Ophthalmology, Kuki Kawashima Eye Clinic, Keio University, 35 Shinanomachi, Shinjukuku, Tokyo 160-8582, Japan.
⁵ Department of Ophthalmology, Omiya Hamada Eye Clinic, 1-169-1 Sakuragicho, Omiyaku, Saitama 330-0854, Japan.
⁶ Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, 2-15 Yamadaoka, Suita 565-0871, Japan.
⁷ Department of Ophthalmology, The University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo 113-8655, Japan.
⁸ Department of Ophthalmology, Toho University Omori Medical Center, 6-11-1 Omorinishi, Otaku, Tokyo 143-8541, Japan.
⁹ Division of Cornea and Ocular Surface, Ohshima Eye Hospital, 11-8 Kamigofukumachi, Hakataku, Fukuoka 812-0036, Japan.

Abstract

Symptom overlap between meibomian gland dysfunction (MGD) and dry eye (DE) makes it difficult to distinguish between these two conditions on the basis of symptoms alone. We searched for characteristic symptoms that might help to distinguish MGD from DE on the basis of a population-based study. Subjects comprised 311 residents of Takushima island (18 to 96 years), including 117 individuals with MGD and 114 with DE. Responses to a symptom-related questionnaire (19 items) were subjected to factor analysis, and univariate regression analysis was performed to identify ocular surface parameters associated with characteristic symptoms of MGD. Factor analysis revealed aggregation of symptoms according to three factors: Factor 1 related to Symptom Score, Factor 2 to DE, and Factor 3 to MGD. Symptoms associated with DE included 11 items, whereas the only item related to MGD was tearing sensation. Pearson's correlation analysis revealed that tearing sensation was associated with tear meniscus height (TMH), noninvasive tear-film breakup time, fluorescein staining score, meiboscore, meibum grade, and Schirmer value. Subjects with MGD experienced significantly more tearing and had a larger TMH than did those without MGD (p = 0.0334). Tearing sensation may thus be a characteristic symptom of MGD. Physicians should suspect MGD who complain of tearing sensation.

Keywords: dry eye; meibography; meibomian gland; meibomian gland dysfunction; meiboscore; ocular symptom; population-based study; tearing sensation.