https://doi.org/10.30702/Ophthalmology.2017/07.art2

Bezditko P. A., Ivzhenko L. I.

Kharkiv National Medical University, Kharkiv, Ukraine

Abstract

Introduction. Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion. Diabetic polyneuropathy can be a cause of MGD. 

 Purpose. To improve the efficacy of diagnosis of MGD in patients with symptomatic A- and B-diabetic polyneuropathy.

 Material and methods. Standard ophthalmological examination, the Schirmer’s test before and 2 hours after eyelid compression, the Norn’s test, the OPI test, a compression test, an IVAD test, contact meibography with green filter were performed. Symptomatic A (N2A) stage of DPN were recorded in 31 patients (62 eyes). Symptomatic B (N2B) stage of DPN were recorded in 34 patients (68 eyes). A control group consisted of 97 persons (194 eyes) without diabetes.

 Results. The Shirmer test was 1.7 and 2.2 times reduced in patients with N2A (5.87 mm) and with N2B (7.34 mm) stages in comparison with that in the control group (12.82) (p < 0.001). The Norn test was 1.7 and 2.3 times lower in patients with N2A (5.54 mm) and with N2B (4.22 mm) stages than in patients without diabetes (9.48 sec) (p < 0.001). The OPI test in patients with N2A and N2B stages was 1.6 and 1.7 times lower than that in the control group (p < 0.001). The Schirmer test in patients with N2A and with N2B were 1.6 times higher after compression than before it (p < 0.05). According to mebography, in patients with N2A and N2B, loss area of the meibomian glands corresponded to stage 2 and 3.

Conclusion. The patients with N2A had MGD stage II (41.9 %) and stage III (32.3 %). Stage I of MGD was found in 16.1 %, and stage IV – in 9.7 %. The patients with N2B had MGD stage III (47.1 %). Stage I of MGD was found in 8.8 % patients, stage II – in 26.5 % and stage IV – in 17.6 %.

Keywords: meibomian gland dysfunction, diabetic polyneuropathy, Schirmer's test, contact meibography, secret of meibomian glands. 

REFERENCES

1. Mozherencov VP, Prokofyeva GL, Usova LA. [Eye manifestations of diabetes mellitus]. RMZh “Klinicheskaya Oftalmologiya”. 2002;1:31. (in Russian).
2. Tronko ND. [According to the materials of the 42nd Congress of the European Association for the Study of Diabetes]. Zdorovia Ukrainy. 2006;21(154):10−15. (in Russian).
3. Blackie CA, Korb DR. Recovery time of an optimally secreting meibomian gland. Cornea. 2009;28:293–7. https://doi.org/10.1097/ICO.0b013e31818913b4
4. Bron AJ, Benjamin L, Snibson GR. Meibomian gland disease. Classification and grading of lid changes. Eye (Lond). 1991;5:395–411. https://doi.org/10.1038/eye.1991.65
5. Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, Wilson DM, O’Brien PC, Melton LJ 3rd, Service FJ. Prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in population-based cohort: Rochester Diabetic Neuropathy Study. Neurology. 1993;43(4):817−24.
6. Foulks GN, Bron AJ. Meibomian gland dysfunction: A clinical scheme for description, diagnosis, classification and grading. Ocul Surf. 2003;1(3):107–26.
7. Linton RG, Curnow DH, Riley WJ. The meibomian glands: an investigation into the secretion and some aspects and some aspects of the physiology. Br J Ophthalmol. 1961 Nov; 45(11):718−23.
8. Pflugfelder SC, Tseng S, 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.
9. Savettieri G, Rocca WA, Salemi G, Meneghini F, Grigoletto F, Morgante L, Reggio A, Costa V, Coraci MA, Di Perri R. Prevalence of diabetic neuropathy with somatic symptoms: a door-to-door survey in two Sicilian municipalities. Neurology. 1993;43(6):1115−20.
10. Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011 Mar 30;52(4):1922−9.

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Received: 4 Apr. 2017

Published: December 2017