Age Spectrum of Meibomian Gland Dysfunction: A Cross-Sectional Study

PURPOSE: To characterize age-related variations in symptomatic meibomian gland dysfunction (MGD) clinical manifestations. METHODS: This cross-sectional, hospital-based study included 100 symptomatic Asian MGD individuals (age 20-89 years). Clinical assessments included the Standard Patient Evaluation of Eye Dryness questionnaire, fluorescein tear film break-up time, corneal staining, Schirmer I test without anesthesia, lid margin examination, meibum expressibility, and quality. Interferometry was used to measure lipid layer thickness (LLT), capture blinking patterns, and obtain meibography images, which were analyzed using ImageJ software. Age was analyzed as a continuous variable using linear regression and decade-based comparisons. RESULTS: In symptomatic MGD, younger individuals correlated with more incomplete blinking, reduced LLT, and greater gland distortion (all P < 0.05). Increasing age was positively associated with LLT, meibomian gland (MG) plugging, anterior displacement of the mucocutaneous junction, telangiectasia, MG dropout area, and gland shortening and dropout (all P < 0.05). Multivariate analysis confirmed younger age and absence of MG plugging as independent predictors of reduced LLT. Decade-based analysis confirmed a significant monotonic increase in LLT with advancing age (Jonckheere-Terpstra P < 0.001). CONCLUSIONS: Symptomatic MGD presentations differ with age. Younger patients exhibit incomplete blinking and gland tortuosity with reduced LLT; older patients show lid margin changes with MG dropout and shortening. The paradoxical increase in LLT with age reflects obstructive and compensatory mechanisms rather than improved tear film function, underscoring the need for a multidimensional diagnostic approach incorporating age, MG morphology, and clinical context.