title: [A new classification for meibomian gland diseases with in vivo confocal microscopy].
abstract: BACKGROUND
  Meibomian gland dysfunction (MGD) is a frequent disorder often associated with dry eye disease. Slit-lamp examination with digital expression of the tarsal Meibomian glands allows examination of the contents of the distal Meibomian gland and the meatus. However, the Meibomian epithelium, interglandular space and proximal secretions cannot be clinically assessed. In vivo confocal microscopy (IVCM) is a rapid and non-invasive imaging technique that provides high-resolution images of the ocular surface and eyelids. The primary objective of the present study was to establish a classification of MGD with IVCM. Secondary objectives were to evaluate this scoring system by analyzing the correlation with OSDI, infrared (IR) meibography and Demodex infestation.
  
  
  METHODS
  Forty-six dry eye patients (Ocular Surface Disease Index [OSDI] >13) associated with MGD were enrolled. Ten healthy subjects without dry eye disease or blepharitis were also included as controls. An OSDI questionnaire, clinical examination, IVCM and infrared meibography of the lower lid were performed in all subjects by the same examiner.
  
  
  RESULTS
  A new MGD score was established based on IVCM findings: the first stage was Meibomian obstruction with a clear epithelium, the second stage was an inflammatory state with Meibomian gland obstruction, epithelial and interglandular inflammation, and the last stage was glandular fibrosis. This score was significantly correlated with the meiboscore obtained with infrared meibography (correlation coefficient 0.47, CI95% [0.22-0.66]).
  
  
  CONCLUSIONS
  IVCM of the Meibomian gland complex complements the clinical examination by determining the stage of dysfunction and may help clinicians evaluate and treat MGD.
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France. Electronic address: matthieu.randon@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Randon
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Liang
authors.affiliation: Département d'épidémiologie et recherche clinique, CIC-EC 1425, hôpital Bichat, groupe hospitalier Paris Nord Val-de-Seine, AP-HP, 75018 Paris, France; UMR 1123 ECEVE, hôpital Robert-Debré, université Paris Diderot, Sorbonne Paris Cité, 48, boulevard Serurier, 75019 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Abbas
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France.
authors.forename: S
authors.initials: S
authors.lastname: Michée
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Denoyer
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France.
authors.forename: C
authors.initials: C
authors.lastname: Baudouin
authors.affiliation: Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France.
authors.forename: A
authors.initials: A
authors.lastname: Labbé
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015352:Dry Eye Syndromes / Q000175:diagnosis; D005141:Eyelid Diseases / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000000981:diagnostic imaging* / Q000473:pathology*; D018613:Microscopy, Confocal; D008875:Middle Aged; D011237:Predictive Value of Tests
keywords: Blepharitis; Blépharite; Dry eye disease; Dysfonctionnement des glandes de Meibomius; In vivo confocal microscopy; Infrared meibography; Meibographie infrarouge; Meibomian gland dysfunction; Microscopie confocale in vivo; OCT; Sécheresse oculaire