Risk Factors for Metabolic Syndrome Not Associated With Meibomian Gland Dysfunction

Ophthalmologist pouring eye drops in the eye of a caucasian patient with conjunctivitis.
Close-up shot of moment eye drops fall. Eyedropper releasing fluid into an eye of a caucasian woman. Horizontal photography
Risk factors for metabolic syndrome are associated with dry eye, but not specifically with disease stemming from meibomian gland dysfunction.

Risk factors for metabolic syndrome are not associated with an increase in meibomian gland dysfunction (MGD), according to the results of a study published in Clinical Ophthalmology.

“While a link between MGD and diabetes has been established, the relationship between MGD and metabolic syndrome is less clear,” according to investigators.

The team conducted a retrospective case-control study investigating risk factors for metabolic syndrome in patients with dry eye who presented at an urban outpatient medical center between January 2017 and December 2018. 

Using electronic medical records, they identified patients with a diagnosis of dry eye disease with and without MGD and matched patients based on sex, age, smoking status, race, ethnicity, and body mass index (BMI). Their analysis included patient demographics, anthropometric measurements, medical history, clinical findings, and serologies. 

Overall, 299 patients were included in the study, of whom 163 (54.5%) had MGD. The mean age of all patients was 68.3 years (range, 24-97, 71.9% women, 85.2% White).

The research suggests MGD is not associated with BMI (P =.386), smoking (P =.834), type 2 diabetes mellitus (P =.985), hypertension (P =.197), or hyperlipidemia (cholesterol, P =.649; HDL cholesterol, P =.833; and LDL cholesterol, P =.889; triglycerides, P =.253). However, patients with MGD were more frequently men (64.3% men vs 50.7% women; P =.046) and older age (mean, 64.3 years without MGD vs 71.6 with MGD; P <.001). Patients with MGD also had a slightly higher mean fasting blood glucose than patients without MGD (110.2 vs 105.9, respectively; P =.039).

The limitations of the study included its retrospective design, possible interobserver error, potential selection bias due to the study being conducted at a single center, and inclusion of patients of advanced age, which could have confounded the relationship between fasting lipid abnormalities and MGD.

“Overall, the relationship between dyslipidemia and MGD is unclear. While some evidence exists to support an association, causation remains to be determined,” researchers report.

They also called for prospective studies to determine the variables associated with ocular surface inflammation and pathophysiological changes that underlie dry eye disease.


Mussi N, Haque W, Robertson DM. The association between risk factors for metabolic syndrome and Meibomian gland disease in a dry eye cohort. Clin Ophthalmol. 2021;15(9):3821-3832. doi:10.2147/OPTH.S322461