The relationship between correction modality and clinical signs and symptoms of dry eye and meibomian gland dysfunction in keratoconic patients.

PURPOSE: Individuals with keratoconus (KC) who wear contact lenses (CLs) exhibit increased corneal weakening, a characteristic feature of dry eye disease (DED). This study examined associations between CL modalities and clinical signs and symptoms of DED and meibomian gland dysfunction (MGD) in participants with KC.

METHODS

This cross-sectional prospective study stratified participants with KC according to CL modality: soft, SoftK, rigid gas permeable (RGP) mini-scleral/scleral and non-CL wearers. Visual acuity, aberrometry, invasive and non-invasive tear break-up time (TBUT), tear meniscus height, Schirmer test, meibography, meibomian gland (MG) expressibility (MES) and quality, corneal and conjunctival staining and the lid margin were evaluated. DE was defined as an ocular surface disease index (OSDI) score ≥ 13 with TBUT/NITBUT < 10 s; MGD as DE with >25% MG loss. Statistical analyses included Chi-Square, Kruskal-Wallis and linear regressions.

RESULTS

Forty-six participants with KC (91 eyes, mean age: 45 ± 13, range: 20-69 years): 48 non-CL wearers, 20 soft, 13 RGPs and 10 SoftK wearers were included. DE and MGD prevalence did not differ across groups (DE: 44%, p = 0.60; MGD: 32%, p = 0.79). RGP wearers demonstrated significantly worse visual acuity, root mean square ocular aberrations and upper eyelid MG loss than non-CL wearers (0.30 ± 0.30 vs. 0.71 ± 0.27, 4.89 ± 3.00 vs. 2.79 ± 2.16, 38.60 ± 31.69 vs. 24.52 ± 11.07, respectively, p < 0.03 for all). Soft CL wearers had significantly longer TBUT (b = 1.87, CI: 0.24-1.27, p = 0.004), less lid margin telangiectasia and notching (p = 0.049 and p = 0.03, respectively), while SoftK wearers exhibited more MES grade 1 compared with other sub-groups (p < 0.001). Corneal staining grade 4 was significantly more prevalent among soft wearers (p = 0.049). Corneal and conjunctival staining grade 5 was significantly more prevalent among RGP wearers (p = 0.049). Symptoms did not differ across sub-groups.

CONCLUSION

While DE and MGD prevalence did not differ by CL modality, RGP wearers exhibited more severe ocular surface signs, emphasising the need for regular ocular surface monitoring in participants with KC, particularly RGP wearers.