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Review
. 2016 Mar;100(3):300-6.
doi: 10.1136/bjophthalmol-2015-307415. Epub 2016 Jan 18.

Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction

Christophe Baudouin  1 , Elisabeth M Messmer  2 , Pasquale Aragona  3 , Gerd Geerling  4 , Yonca A Akova  5 , José Benítez-del-Castillo  6 , Kostas G Boboridis  7 , Jesús Merayo-Lloves  8 , Maurizio Rolando  9 , Marc Labetoulle  10
Affiliations
Review

Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction

Christophe Baudouin et al. Br J Ophthalmol. 2016 Mar.

Abstract

Meibomian gland dysfunction (MGD) is the most frequent cause of dry eye disease (DED). Eyelid inflammation, microbial growth, associated skin disorders as well as potentially severe corneal complications culminate to make MGD a complex multifactorial disorder. It is probable that MGD is a heterogeneous condition arising from any combination of the following five separate pathophysiological mechanisms: eyelid inflammation, conjunctival inflammation, corneal damage, microbiological changes and DED resulting from tear film instability. The pathogenesis of both MGD and DED can be described in terms of a 'vicious circle': the underlying pathophysiological mechanisms of DED and MGD interact, resulting in a double vicious circle. The MGD vicious circle is self-stimulated by microbiological changes, which results in increased melting temperature of meibum and subsequent meibomian gland blockage, reinforcing the vicious circle of MGD. Meibomian gland blockage, dropout and inflammation directly link the two vicious circles. MGD-associated tear film instability provides an entry point into the vicious circle of DED and leads to hyperosmolarity and inflammation, which are both a cause and consequence of DED. Here we propose a new pathophysiological scheme for MGD in order to better identify the pathological mechanisms involved and to allow more efficient targeting of therapeutics. Through better understanding of this scheme, MGD may gain true disease status rather than being viewed as a mere dysfunction.

Keywords: Cornea; Inflammation; Ocular surface; Tears; Treatment Medical.

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Figures

Figure 1
Figure 1
Pathways involved in the pathophysiology of meibomian gland dysfunction (MGD) proposed by the 2011 International Workshop on Meibomian Gland Dysfunction.
Figure 2
Figure 2
Proposed vicious circle of the pathology of dry eye disease. MGD, meibomian gland dysfunction.
Figure 3
Figure 3
Importance of meibomian gland dysfunction in the vicious circle of the pathology of dry eye disease.
Figure 4
Figure 4
Different therapies may target particular pathophysiological mechanisms that underlie the vicious circle of dry eye disease.
See this image and copyright information in PMC

References

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