Lid Margin Score Predicts Undiagnosed Meibomian Area Loss

Meibomian Gland, LM
Light micrograph showing the Meibomian gland of a normal eyelid (also known as a tarsal gland).
Since early meibomian gland dropout (MGD) is asymptomatic in the preclinical stage, it is important to predict MGD and initiate early treatment.

Lid margin score is the best predictor of undiagnosed meibomian area loss, and its assessment could assist in early meibomian gland dysfunction (MGD) detection, according to research published in Cornea. 

Researchers recruited 100 participants (age range 18-65 years, 50% women, 50% East Asian ethnicity) with no known allergies to topical anesthetics, no diagnosed conditions that might affect the ocular surface, and no history of injury or surgery to the eyes or eyelids. The team administered the Ocular Surface Disease Index (OSDI) symptom survey and performed biomicroscopy examination, tear film assessment, and meibography. They also obtained noninvasive tear break-up time (TBUT) measurement, bulbar and limbal redness scores, blepharitis score, lipid layer thickness, the number of parallel conjunctival folds, tear osmolarity, corneal fluorescein staining, phenol red thread test measurement, and lid margin score. 

Researchers found correlations between meibomian area and lid margin score (r = -0.47, P <0.01), and meibomian tortuosity and lid signs of blepharitis (r = -0.32, P< 0.01). They noted a negative association between lid margin score and meibomian area, and that a healthier lid margin condition was associated with healthier glands. The team also determined that a lid margin score of 1.70 or higher predicted meibomian area loss with 0.58 sensitivity and 0.86 specificity, and meibomian area correlated with orifice area at 30 µm depth (r = -0.25, P = 0.01), according to the report. 

“Early MGD is asymptomatic in the preclinical stage,” according to the researchers. “It is important to identify which characteristics are likely to be predictive of MG dropout because early treatment might delay the further progression of MGD.”

Study limitations include convenience sampling and a single center design.


Zhou N, Edwards K, Colorado LH, Schmid KL. Lid margin score is the strongest predictor of meibomian area loss. Cornea. 2022;41(6):699-708. doi:10.1097/ICO.0000000000002913