Dry Eye and Meibomian Gland Dysfunction in Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Injections

Turk J Ophthalmol. 2022 Jun 29;52(3):157-161. doi: 10.4274/tjo.galenos.2021.66168.


Objectives: To determine if patients treated with multiple intravitreal injections for neovascular age-related macular degeneration are more likely to suffer from dry eye and meibomian gland dysfunction.

Materials and methods: Sixty eyes of 30 patients were enrolled. One eye of each patient was treated with multiple monthly intravitreal injections for neovascular AMD (Group 1) and the fellow healthy eye received no treatment (Group 2). The presence of dry eye was evaluated using tear film break-up time, Schirmer 1 test, the Oxford scale, and Ocular Surface Disease Index (OSDI). The loss rate of meibomian glands was evaluated by meibography and was graded and scored (meiboscore) from grade 0 (no loss of glands) to grade 3 (loss of >2/3 of total meibomian glands) for each eyelid.

Results: Group 1 had lower mean Schirmer 1 and tear film break up-time measurements and higher mean OSDI score than Group 2, but the differences were not statistically significant (p=0.257, p=0.113, and p=0.212, respectively). Mean Oxford scale scores and meiboscore of the upper eyelids showed no statistically significant difference between the groups (p=0.594, p=0.663, respectively). The meiboscore of the lower eyelids was significantly higher in Group 1 (p=0.048).

Conclusion: Multiple factors such as povidone-iodine and the preservatives in topical eye drops may cause inflammation leading to ocular surface damage in patients treated with multiple intravitreal injections. As the treatment requires repeated injections, exposure to these factors might worsen the ocular surface inflammation. The possibility of dry eye and meibomian gland dysfunction should be considered in these patients.

Keywords: Intravitreal injection; dry eye; meibography; meibomian gland dysfunction; neovascular age-related macular degeneration.

MeSH terms

  • Angiogenesis Inhibitors
  • Dry Eye Syndromes* / diagnosis
  • Dry Eye Syndromes* / drug therapy
  • Dry Eye Syndromes* / etiology
  • Humans
  • Inflammation / complications
  • Intravitreal Injections
  • Meibomian Gland Dysfunction*
  • Meibomian Glands
  • Vascular Endothelial Growth Factor A
  • Visual Acuity
  • Wet Macular Degeneration* / complications
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy


  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A