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Purpose <p>This study aimed to investigate the differential impairment of meibomian glands (MGs) in the upper and lower eyelids among postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO). Additionally, we evaluated the correlations between MG morphological and functional parameters and clinical indicators of tear film stability.</p> Methods <p>A total of 115 eyes from 115 postmenopausal women with PANDO and 115 eyes from 115 matched control subjects were enrolled in the study. Upper and lower MG loss, and non-invasive tear meniscus height (NITMH) were evaluated using the Keratograph 5&#xa0;M. Tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and Marx’ lines were all examined using a slit-lamp biomicroscope.</p> Results <p>Compared to controls, the PANDO group exhibited significantly higher MG loss scores in both the upper (<i>p</i> = 0.045) and lower (<i>p</i> = 0.036) eyelids, and worse meibum quality in the upper eyelids (<i>p</i> = 0.049). Marx’s lines scores were significantly more severe in the PANDO group for both eyelids (upper: <i>p</i> &lt; 0.001; lower: <i>p</i> = 0.02). Within the PANDO group, the MG loss score was significantly higher in the upper eyelid compared to the lower eyelid (<i>p</i> &lt; 0.001). The meibum grade score also showed a significantly higher value in the upper eyelid relative to the lower eyelid (<i>p</i> = 0.045). In contrast, the Marx’s lines score was significantly lower in the upper eyelid than in the lower eyelid (<i>p</i> = 0.032). Furthermore, the meibum grades of both the upper (<i>p</i> = 0.035) and lower (<i>p</i> = 0.001) eyelids demonstrated a negative correlation with TBUT, but no significant association was observed with CFS. However, no correlation was found between MG loss in either eyelid and TBUT or CFS.</p> Conclusions <p>Postmenopausal women with PANDO show greater impairment in the upper MGs than in the lower MGs.This pattern may be a distinctive feature of ocular surface damage in this population. These findings provide new insights into PANDO-related ocular changes and may inform clinical assessment and management.</p>

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Upper eyelid predominance of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction

  • 期刊论文

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  • 发表日期：

    2025年10月29日

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  • Haili Jin,
  • Xianjie Chen,
  • Yin Liu

摘要

Purpose

This study aimed to investigate the differential impairment of meibomian glands (MGs) in the upper and lower eyelids among postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO). Additionally, we evaluated the correlations between MG morphological and functional parameters and clinical indicators of tear film stability.

Methods

A total of 115 eyes from 115 postmenopausal women with PANDO and 115 eyes from 115 matched control subjects were enrolled in the study. Upper and lower MG loss, and non-invasive tear meniscus height (NITMH) were evaluated using the Keratograph 5 M. Tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade, and Marx’ lines were all examined using a slit-lamp biomicroscope.

Results

Compared to controls, the PANDO group exhibited significantly higher MG loss scores in both the upper (p = 0.045) and lower (p = 0.036) eyelids, and worse meibum quality in the upper eyelids (p = 0.049). Marx’s lines scores were significantly more severe in the PANDO group for both eyelids (upper: p < 0.001; lower: p = 0.02). Within the PANDO group, the MG loss score was significantly higher in the upper eyelid compared to the lower eyelid (p < 0.001). The meibum grade score also showed a significantly higher value in the upper eyelid relative to the lower eyelid (p = 0.045). In contrast, the Marx’s lines score was significantly lower in the upper eyelid than in the lower eyelid (p = 0.032). Furthermore, the meibum grades of both the upper (p = 0.035) and lower (p = 0.001) eyelids demonstrated a negative correlation with TBUT, but no significant association was observed with CFS. However, no correlation was found between MG loss in either eyelid and TBUT or CFS.

Conclusions

Postmenopausal women with PANDO show greater impairment in the upper MGs than in the lower MGs.This pattern may be a distinctive feature of ocular surface damage in this population. These findings provide new insights into PANDO-related ocular changes and may inform clinical assessment and management.