Evaluation of the effect of eyelid disorder surgeries on tears and anterior segment parameters with meibography and corneal topography: Eyelid disorder surgeries and meibography

Mehmet Gülal; Özgür Eroğul

doi:10.28982/josam.7371

Authors

Mehmet Gülal Department of Opthalmology, Afyonkarahisar Health Science University, Faculty of Medicine, Afyonkarahisar, TURKEY https://orcid.org/0000-0002-3928-9011
Özgür Eroğul Department of Opthalmology, Afyonkarahisar Health Science University, Faculty of Medicine, Afyonkarahisar, TURKEY https://orcid.org/0000-0002-0875-1517

DOI:

https://doi.org/10.28982/josam.7371

Keywords:

Eyelid surgeries, Meibography, Meibomian gland dysfunction, Corneal topography.

Abstract

Background/Aim: Abnormalities of eyelid shape, including ptosis, entropion, ectropion, lagophthalmos, and dermatochalasis, can occur at any age and affects the patient’s life quality, visual functions, and comfort. These abnormalities can be regarded as illnesses and can be cured medically and surgically. Meibomian glands are large sebaceous glands located in the lower and upper eyelids. Our study aimed to observe changes in anterior cornea segment parameters and meibomian glands of patients undergoing surgery for eyelid shape abnormalities.

Methods: Our sample comprised 31 patients, who were operated on at Afyonkarahisar Health Sciences University Hospital, were examined with respect to cornea topographic measurements and the drop-out of meibomian glands at the pre-operative and first-month post-operative processes and post-operative third month. In this prospective cohort method study, the surgical eyes of the patients were determined as the study group and the healthy eyes as the control group.

Results: Surgical and healthy eyes of 31 patients were included in this study (N=62). The sample comprised 18 male and 13 female patients. The average age and standard deviation values of patients were determined as 66.50 (17.315) in males and 65.92 (13.714) (P = 0.659) in females. In terms of anterior cornea segment parameters (K1, K2, ACA, ACD, ACV, and CCT), no prominent differences were found in pre-operative and post-operative results (K1, K2, ACA, ACD, ACV, and CCT) in both the study and control groups. Meibography revealed that the increased meibomian gland drop-out of surgical eye measurements of pre- and post-operative was statistically significant (P < 0.001), whereas the change seen in healthy eyes was not statistically significant (P = 0.051). Furthermore, although the change through meibomian glands of entropion patients was not significant (P = 0.066), the drop-out of the meibomian gland of the other surgery cases (ptosis, ectropion, lagophthalmos, blepharoplasty, and dermatochalasis surgery) was found to be statistically significant (P = 0.038).

Conclusion: Surgeries to correct abnormalities in eyelid shape can lead patients to meibomian gland drop-out. Pre-operative assessment of patients whose surgeries are planned, and post-operative monitoring, must be done meticulously in order to minimize the likelihood of symptoms and avoid meibomian gland dysfunction.

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References

Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Ian Pearce E, et al. The international workshop on meibomian gland dysfunction: Report of the diagnosis subcommittee. Investig Ophthalmol Vis Sci. 2011;52(4):2006–49. DOI: https://doi.org/10.1167/iovs.10-6997f

Jester JV, Rife L, Nii D, Luttrull JK, Wilson L, Smith RE. In vivo biomicroscopy and photography of meibomian glands in a rabbit model of meibomian gland dysfunction. Investig Ophthalmol Vis Sci. 1982;22(5):660–7.

Ngo W, Srinivasan S, Jones L. Historical overview of imaging the meibomian glands. J Optom. 2013;6(1):1–8. DOI: https://doi.org/10.1016/j.optom.2012.10.001

Mathers WD, Daley T, Verdick R. Video Imaging of the Meibomian Gland. Arch Ophthalmol. 1994 Apr;112(4):448–9. DOI: https://doi.org/10.1001/archopht.1994.01090160022008

Arita R, Itoh K, Inoue K, Amano S. Noncontact Infrared Meibography to Document Age-Related Changes of the Meibomian Glands in a Normal Population. Ophthalmology. 2008;115(5):911–5.

Pult H, Nichols JJ. A review of meibography. Optom Vis Sci Off Publ Am Acad Optom. 2012;89(5):760-9.

Nichols JJ, Berntsen DA, Mitchell GL, Nichols KK. An assessment of grading scales for meibography images. Cornea. 2005;24(4):382–8.

McCann LC, Tomlinson A, Pearce EI, Diaper C. Tear and meibomian gland function in blepharitis and normals. Eye Contact Lens. 2009;35(4):203–8. DOI: https://doi.org/10.1097/ICL.0b013e3181a9d79d

Mathers WD, Shields WJ, Sachdev MS, Petroll WM, Jester J V. Meibomian gland dysfunction in chronic blepharitis. Cornea. 1991;10(4):277–85. DOI: https://doi.org/10.1097/00003226-199107000-00001

Pult H, Riede-Pult BH. Non-contact meibography: keep it simple but effective. Cont Lens Anterior Eye. 2012;35(2):77–80. DOI: https://doi.org/10.1016/j.clae.2011.08.003

Chan TCY, Chow SSW, Wan KHN, Yuen HKL. Update on the association between dry eye disease and meibomian gland dysfunction. Hong Kong Med J. 2019;25(1):38–47. DOI: https://doi.org/10.12809/hkmj187331

Lelli GJ Jr1, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010; 125(3):1007-17. DOI: https://doi.org/10.1097/PRS.0b013e3181ce17e8

Chang P, Qian S, Xu Z, Huang F, Zhao Y, Li Z, et al. Meibomian Gland Morphology Changes After Cataract Surgery: A Contra-Lateral Eye Study. Front Med. 2021;29;8:766393. DOI: https://doi.org/10.3389/fmed.2021.766393

Klein-Theyer A, Horwath-winter J, Dieter FR, Haller-Schober E-M, Riedl R, Boldin I. Evaluation of ocular surface and tear film function following modified Hughes tarsoconjunctival flap procedure. Acta Ophthalmol. 2014;92(3):286-90. DOI: https://doi.org/10.1111/aos.12034

Yang MK, Sa H-S, Kim N, Jeon HS, Hyon JY, Choung H, et al. Quantitative analysis of morphological and functional alterations of the meibomian glands in eyes with marginal entropion. PLoS One [Internet]. 2022;17(4):e0267118. Doi: 10.1371/journal.pone.0267118 DOI: https://doi.org/10.1371/journal.pone.0267118

Vaidya A, Kakizaki H, Takahashi Y. Postoperative changes in status of meibomian gland dysfunction in patients with involutional entropion. Int Ophthalmol [Internet]. 2020;40(6):1397–402. DOI: https://doi.org/10.1007/s10792-020-01305-8

Aksu Ceylan N, Yeniad B. Effects of Upper Eyelid Surgery on the Ocular Surface and Corneal Topography. Turkish J Ophthalmol. 2022;52(1):50–6. DOI: https://doi.org/10.4274/tjo.galenos.2021.63255

Zinkernagel MS, Ebneter A, Ammann-Rauch D. Effect of upper eyelid surgery on corneal topography. Arch Ophthalmol. 2007;125(12):1610–2. DOI: https://doi.org/10.1001/archopht.125.12.1610

Savino G, Battendieri R, Riso M, Traina S, Poscia A, DʼAmico G, et al. Corneal Topographic Changes After Eyelid Ptosis Surgery. Cornea. 2016; 35(4):501-5. DOI: https://doi.org/10.1097/ICO.0000000000000729

Assadi FA, Narayana S, Yadalla D, Rajagopalan J, Joy A. Effect of congenital ptosis correction on corneal topography- A prospective study. Indian J Ophthalmol. 2021 Jun;69(6):1527–30. DOI: https://doi.org/10.4103/ijo.IJO_2650_20

Youssef Y.A, Abo-eleinin M.A, Salama O.H. Corneal Topographic Changes after Eyelid Ptosis Surgery. AIMJ 2020;9:236-241. DOI: https://doi.org/10.21608/aimj.2020.38021.1291

Nalci H, Hoşal MB, Gündüz ÖU. Effects of upper eyelid blepharoplasty on contrast sensitivity in dermatochalasis patients. Turkish J Ophthalmol. 2020;50(3):151–5. DOI: https://doi.org/10.4274/tjo.galenos.2019.95871

Eshraghi B, Jamshidian-Tehrani M, Fadakar K, Gabriel J, Tafti Z, Ghaffari R. Vector analysis of changes in corneal astigmatism following lateral tarsal strip procedure in patients with involutional ectropion or entropion. Int Ophthalmol. 2019;39(8):1679-85. DOI: https://doi.org/10.1007/s10792-018-0987-y

Yunoki T, Hayashi A, Abe S, Otsuka M. Corneal Topographic Analysis in Patients with Involutional Lower Eyelid Entropion. Semin Ophthalmol. 2021;36(8):599–604. DOI: https://doi.org/10.1080/08820538.2021.1890787

Simsek IB, Yilmaz B, Yildiz S, Artunay O. Effect of Upper Eyelid Blepharoplasty on Vision and Corneal Tomographic Changes Measured by Pentacam. Orbit (London). 2015;34(5):263–7. DOI: https://doi.org/10.3109/01676830.2015.1057292

Monga P, Gupta V, Dhaliwal U. Clinical evaluation of changes in cornea and tear film after surgery for trachomatous upper lid entropion. Eye (Lond).2008; 1(22):912–7. DOI: https://doi.org/10.1038/sj.eye.6702768

Abd El-Ghany Mohammed Z, Amin Anwar El-Masry M, Abd El-Samie El-Shiekh E. Corneal Topographic Changes After Eyelid Ptosis Surgeries Measured By Corneal Topography. Al-Azhar Med J. 2021;50(2):1119–26. DOI: https://doi.org/10.21608/amj.2021.158461

Koçer A, Sen E. Pupillary and Anterior Chamber Changes Following Upper Eyelid Blepharoplasty. Ophthalmic Plast Reconstr Surg. 2021;37(5):465-9. DOI: https://doi.org/10.1097/IOP.0000000000001917

Pult H, Nichols JJ. A Review of Meibography. Optometry and Vision Science. 2012;89(5):760-9. DOI: https://doi.org/10.1097/OPX.0b013e3182512ac1

Pflugfelder SC, Tseng SC, Sanabria O, Kell H, Garcia CG, Felix C, Feuer W, Reis BL. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea 1998;17:38–56. DOI: https://doi.org/10.1097/00003226-199801000-00007

Nichols JJ, Berntsen DA, Mitchell GL, Nichols KK. An assessment of grading scales for meibography images. Cornea 2005;24:382–8. DOI: https://doi.org/10.1097/01.ico.0000148291.38076.59

Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 2008;115:911–5. DOI: https://doi.org/10.1016/j.ophtha.2007.06.031

Pult H, Riede-Pult BH. Non-contact meibography in diagnoses and treatment of non-obvious meibomian gland dysfunction. J Optom 2012;5:2–5. DOI: https://doi.org/10.1016/j.optom.2012.02.003