The Meibomian Gland Composite Score (MGCS): A Novel Grading System Integrating Existing Scales for Meibomian Gland Dysfunction.

PURPOSE: To introduce and evaluate the clinical performance of the Meibomian Gland Composite Score (MGCS), a novel, standardized, video- and pictorial-based grading system designed to provide a linear, gland-specific assessment of meibomian gland dysfunction (MGD) severity.

METHODS

The MGCS evaluates meibum quality on a 0 to 4 scale based on texture and expressibility across the central 8 upper eyelid glands (score 0-32) and central 5 lower eyelid glands (score 0-20). To evaluate clinical performance, two independent providers performed a retrospective chart review of 53 patients (mean age 60.9 ± 16.4 years; 75.5% female). Receiver operating characteristic (ROC) curves were generated using tear breakup time (TBUT ≤5 seconds) as the reference standard for evaporative dry eye disease (DED) to determine optimal diagnostic cut points.

RESULTS

The MGCS demonstrated strong diagnostic accuracy for evaporative DED, with area under the curve (AUC) values of 0.9539 (right upper eyelid), 0.9182 (right lower eyelid), 0.9105 (left upper eyelid), and 0.7779 (left lower eyelid). An MGCS score ≥10 for an individual eyelid provided optimal diagnostic balance (sensitivity up to 93.75%, specificity up to 85.71%) for identifying abnormal gland function.

CONCLUSION

The MGCS offers a standardized and continuous scale for assessing MGD severity. By incorporating detailed meibum texture descriptions supported by standardized pictorial and video references, the scale facilitates precise disease tracking and robust statistical analysis in both clinical practice and research settings.