Meibomian glands and ocular surface inflammation

The purpose of this review was to systematically analyze publications related to the role of meibomian gland disease in ocular surface inflammation, with special reference to meibomitis as an inflammatory form of meibomian gland dysfunction (MGD). Meibomian gland inflammation is often present with the ocular surface inflammation in conditions such as blepharokeratoconjunctivitis, ocular rosacea, and phlyctenular keratitis, but its contribution is often overlooked, especially in younger subjects. This can result in misdiagnosis, mistreatment, and, sometimes, severe visual impairment. We identified a related disease entity, seen predominantly in young patients, of ocular surface inflammation associated with meibomitis, which we termed meibomitis-related keratoconjunctivitis. Its specific clinical features are similar to those observed in the above-mentioned diseases, and the inflammatory form of MGD was found to be closely involved in the ocular surface inflammation seen in those four diseases, based on our statistical evaluation. The diagnosis and management of meibomitis, an inflammatory form of MGD, is vital for the successful treatment of the induced ocular surface inflammation. We propose that the ocular surface and the adnexal meibomian glands should be considered as one unit, i.e., the "meibomian gland and ocular surface" (MOS), when encountered in the clinical setting.