Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population

Purpose: To examine the morphologic changes in meibomian glands associated with aging and gender using a novel meibography system and to assess their relation with slit-lamp findings regarding eyelid and tear film function in a normal population. Design: Cross-sectional observation case series. Participants: Two hundred thirty-six healthy volunteers (114 men, 122 women; mean age +/- standard deviation, 41.2 +/- 23.1 years; range, 4-98 years). Methods: The upper and lower eyelids were turned over and the meibomian glands were observed using the noncontact meibography system, which consisted of a slit lamp equipped with an infrared charge-coupled device video camera and an infrared transmitting filter. A transilluminating light probe was not necessary. Partial or complete loss of the meibomian glands was scored for each eyelid from grade 0 (no loss of meibomian glands) through grade 3 (the lost area was more than two thirds of the total meibomian gland area). The tear film break-up time (BUT) was measured and tear film production was evaluated by Schirmer test. Main Outcome Measures: Score of meibomian gland changes (meiboscore), tear film BUT, and Schirmer test value. Results: Using the meibography system, clear images of the meibomian glands were obtained in all subjects, including children. There were significant positive correlations between age and meiboscore in the entire subject population (R = 0.428; P<0.0001), as well as in males (R = 0.462; P<0.0001) and females (R = 0.418; P<0.0001). There were significant negative correlations between age and tear film BUT (R = -0.153; P = 0.019) and the Schirmer test value (R = -0.289; P<0.0001). The meiboscore was significantly positively correlated with the lid margin abnormality score (R = 0.359; P<0.0001). Conclusions: The noncontact meibography system is a useful, quick, and patient-friendly method for obtaining information on the meibomian glands increase with age.