Clinically relevant immune-cellular metrics of inflammation in meibomian gland dysfunction

Yureeda Qazi, Ahmad Kheirkhah, Caroline Blackie, Monique Trinidad, Candice Williams, Andrea Cruzat, Donald R. Korb, Pedram Hamrah

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


PURPOSE. To determine the reliability and clinical relevance of in vivo confocal microscopy (IVCM)-based immune-cellular metrics of palpebral conjunctival inflammation in meibomian gland dysfunction (MGD). METHODS. Sixteen MGD patients and 13 reference controls included in this cross-sectional, retrospective study, had an ocular surface exam, symptom assessment (Ocular Surface Disease Index questionnaire [OSDI]), and palpebral conjunctival IVCM imaging. Bland-Altman analyses, intraclass correlation coefficient (ICC a ), Lin’s concordance correlation coefficient (q c ), receiver operating characteristic (ROC) analyses, and correlations were performed. Clinical outcome measures were symptom severity (OSDI scores), tear break-up time (TBUT), and corneal fluorescein staining (CFS grade). RESULTS. Compared to controls, patients with MGD had variable symptom severity (average OSDI score: 48.3 ± 7.6, P = 0.0008, range: 8.3–85.42), shorter TBUT (6.8 ± 0.9 seconds, P = 0.002), comparable corneal staining (0.31 ± 0.19, P = 0.20), and greater conjunctival inflammation (epithelial immune cells [EIC]: 477.8 ± 54.2 vs. 123.3 ± 17.2 cells/mm 2 , P < 0.0001; intraglandular immune cells [IGIC]: 41.9 ± 3.3% vs. 20.33 ± 7.3%, P < 0.01). Immune-cellular metrics had high inter-and intraobserver agreement (q c : 0.86–0.94; ICC a and Cronbach’s α: 0.85–0.97, P < 0.0001). EIC correlated positively with OSDI (r s : 0.49, P = 0.03), while both EIC and IGIC correlated inversely with TBUT (r s : 0.47, 0.45, P < 0.05), and had high accuracy in detecting inflammation (ROC area under the curve [AUC]: 0.97 and 0.89, P ≤ 0.001). CONCLUSIONS. EIC and IGIC are increased in highly symptomatic patients with MGD that have minimal corneal staining, and correlate with symptoms and clinical signs. EIC and IGIC may provide reliable and clinically relevant metrics of inflammation.

Original languageEnglish (US)
Pages (from-to)6111-6123
Number of pages13
JournalInvestigative Ophthalmology and Visual Science
Issue number15
StatePublished - Dec 2018
Externally publishedYes


  • Confocal microscopy
  • Dry eye
  • Inflammation
  • MGD

ASJC Scopus subject areas

  • Sensory Systems
  • Cellular and Molecular Neuroscience
  • Ophthalmology


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