Meibomian Gland Atrophy May Be Underdiagnosed in Patients With Cataracts

Patients presenting for a cataract surgery can benefit from meibography to ensure quick MGD diagnosis and treatment and better surgical outcomes.

Meibomian gland (MG) atrophy is common among patients presenting for a cataract surgery evaluation, according to a study published in Cornea. These findings indicate a potential meibomian gland atrophy underdiagnosis and suggest that clinicians perform routine meibography screenings in patients undergoing cataract surgery.  

Researchers retrospectively analyzed data from 391 patients (60.1% women; mean age, 68.5 years) who underwent a cataract surgery workup with meibography. The team graded MG atrophy (0, no atrophy;  1, 1%-33% atrophy; 2, 34%-66% atrophy; 3, >66% atrophy), meibum secretion (1, clear; 2, cloudy; 3, cloudy with debris; 4, toothpaste consistency) and telangiectasia (0, none; 1, mild; 2, moderate; 3, severe; 4, florid) and evaluated associations between MG atrophy and age, sex, ethnicity, various comorbidities, previous dry eye disease (DED) diagnosis, and other factors.

“MG [dysfunction]-associated DED alters the tear film and overall integrity of the ocular surface, which is vital for refractive planning of cataract surgery,” the study authors note. “An unstable tear film in patients with cataract may lead to erroneous keratometric measurements during the preoperative workup, thus leading to inaccurate intraocular lens (IOL) calculations and presurgical planning for astigmatism management.”

Among the cohort, 95.1% of patients (n=372) had MG atrophy of grade 1 or higher. of A total of 50.4% (n=197) had grade 1, 25.8% (n=101) had grade 2, and 18.9% (n=74) had grade 3 atrophy. MG atrophy was significantly associated with expressibility (r, 0.22; P =.001), but not with meibum grade (r, 0.103; P =.123) or telangiectasia (r, 0.014; P =.787).

[I]t is an important consideration to perform meibography in all patients with cataract, not just those with severe symptoms or poor MG function.

MG atrophy prevalence was comparable among patients who had previously been diagnosed with dry eye disease (DED) versus those who had not, but the severity of atrophy was higher among patients with a previous diagnosis compared with those without a DED diagnosis (grade 2 or 3: 59% vs no diagnosis: 30.9%), according to the report. Sex- and ethnicity-based stratifications failed to reveal any significant differences in meibomian gland atrophy.

“[O]ur findings indicate that MG [dysfunction] with true MG structural changes would have been missed in some patients with good MG function, had meibography not been performed,” according to the researchers. “Therefore, it is an important consideration to perform meibography in all patients with cataract, not just those with severe symptoms or poor MG function.”

Study limitations include a single-center design and retrospective nature.

Disclosure: This research was supported by Johnson & Johnson Surgical Vision, Inc. Please see the original reference for a full list of disclosures.


Yeu E, Koetting C, Calvelli H. Prevalence of meibomian gland atrophy in patients undergoing cataract surgery. Cornea. Published online January 12, 2023. doi:10.1097/ICO.0000000000003234