Relationship Between Chronic Ocular Surface and Meibomian Gland Changes and Clinical Assessment Tool in Cicatricial Conjunctival Diseases.

PURPOSE: This study aimed to evaluate long-term structural and functional changes in the meibomian glands and lid margin keratinization after the chronic and quiescent phase of cicatricial conjunctival diseases. Additionally, the study explored the impact of these changes on dry eye severity and the ocular surface, as well as their correlation with comprehensive composite symptom scoring.

METHODS: A total of 64 patients were included: 22 with ocular cicatricial pemphigoid (OCP), 24 with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN), and 18 with graft-versus-host disease (GVHD). Patients were evaluated using the "Cicatrising Conjunctivitis Assessment Tool," and previous ocular surgeries were recorded. Tear film function (Schirmer, TBUT, NI-BUT), meibomian glands and lid margin changes, and OSDI scores were documented.

RESULTS: Meibomian gland dysfunction (MGD) and dry eye were the most common chronic findings. OCP patients had the highest composite scores and meibomian gland changes, while GVHD patients exhibited more severe dry eye. Significant correlations were found between scarring severity and MGD parameters (expression, r = 0.426, p < 0.001; secretion quality, r = 0.425, p < 0.001; lid margin changes, r = 0.439, p < 0.001). Disease severity was significantly linked to OSDI and TBUT (r = 0.506, p < 0.001; r = -0.257, p = 0.041). Lid margin keratinization was not significantly different among groups (p = 0.098) but was associated with more severe MGD (p = 0.029).

CONCLUSION: In ocular cicatricial diseases, lid margin keratinization and MGD play a critical role in determining long-term ocular surface survival and functional recovery, depending on disease severity. A comprehensive and new clinical scoring system may help improve patient classification and treatment strategies.