International Journal of Medical Sciences And Clinical Research
6
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VOLUME
Vol.05 Issue05 2025
PAGE NO.
6-10
10.37547/ijmscr/Volume05Issue05-02
Functional State of Meibomian Glands in Military
Personnel with Symptoms of Dry Eye Syndrome
Abdullaev Sh.R.
Doctor of Medical Sciences, Associate Professor at the Department of Ophthalmology, Center for Professional Qualification
Development of Medical Workers, Uzbekistan
Mamatov J.F.
Independent Researcher at the Military Medical Academy of the Armed Forces of the Republic of Uzbekistan, Ophthalmologist, Deputy
Chief Surgeon at AKFA Medline University Hospital, Uzbekistan
Received:
09 March 2025;
Accepted:
05 April 2025;
Published:
08 May 2025
Abstract:
Meibomian gland dysfunction (MGD) is considered a key pathogenic factor in the development of dry
eye syndrome (DES). The aim of this study was to assess the anatomical and functional state of the meibomian
glands in military personnel with symptoms of DES using the LacryDiag diagnostic system. Materials and Methods.
A total of 120 military personnel (240 eyes) with complaints of DES symptoms were examined. Two control groups
were formed: individuals with DES symptoms not serving in the military (n=40), and healthy participants (n=40).
The study utilized meibography methods, visualization with LacryDiag, and calculation of the meibomian gland
dysfunction index (MGDI). Gland density analysis was performed using the ImageJ software. Results. In the group
of military personnel, the average meibomian gland density was 28.6%, corresponding to moderate atrophy. In
control group 1, the value reached 51.4%, and in control group 2
—
over 70%. The average MGDI value in the
main group was 1.58±0.34 points, compared to 1.22±0.22 and 0.48±0.11 in the respective control groups (p<0.05).
A strong positive correlation was established between the OSDI index and MGDI in military personnel (r=0.701).
Conclusion. Military personnel demonstrate more pronounced meibomian gland dysfunction than civilian
individuals, which confirms the need for in-depth diagnosis and prevention of DES using high-precision methods
such as LacryDiag.
Keywords:
Dry eye syndrome, meibomian glands, LacryDiag, dysfunction, military personnel.
Introduction:
Dry eye syndrome (DES) is a widespread
condition characterized by tear film instability and
inflammation of the ocular surface, accompanied by
subjective symptoms such as burning, itching, foreign
div sensation, and dryness [1,2,3]. Meibomian gland
dysfunction (MGD), as one of the leading causes of DES,
has
attracted
considerable
attention
from
ophthalmologists and researchers due to its significant
contribution to the disease pathogenesis. Military
personnel, as a specific patient population, are exposed
to a variety of adverse factors including stress,
prolonged outdoor activity, the use of protective
eyewear, and limited access to medical care [4,5,6,7].
These conditions may contribute to the development
or exacerbation of MGD, thereby increasing the
frequency and severity of DES symptoms in this group.
Diagnosing MGD requires both clinical assessment and
the use of modern instrumental methods. The
LacryDiag system provides objective evaluation of the
anatomical and functional status of the meibomian
glands, allowing for high-precision visualization of
gland damage. The use of this method enables a more
detailed study of MGD-related changes in military
personnel [1,8,9,10]. The present study aims to identify
specific features of MGD in military personnel with DES
symptoms and to perform a comparative analysis with
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
civilian individuals exhibiting similar symptoms or no
ophthalmological pathology.
Objective of the Study
. To assess the degree of
meibomian gland dysfunction in military personnel
with symptoms of dry eye syndrome (DES) using the
LacryDiag diagnostic system, and to compare the
findings with control groups of civilians both with and
without DES symptoms.
METHODS
The study included 120 military personnel (240 eyes)
with complaints of ocular discomfort associated with
dry eye syndrome (DES) symptoms such as burning,
itching, foreign div sensation, and dryness. The
participants served in various units of the Armed Forces
of the Republic of Uzbekistan. The mean age of the
participants was 23.4±4.5 years, of whom 95 (79.2%)
were men and 25 (20.8%) were women.
Inclusion criteria:
Conscription age (18
–
27 years);
Presence of ocular discomfort related to DES symptoms
(burning, itching, foreign div sensation, dryness);
Signed informed consent to participate in the study.
Exclusion criteria:
History of ophthalmic diseases causing secondary DES
(chemical burns, severe conjunctivitis, etc.);
Presence of ophthalmic diseases that could distort
study results (excluding DES);
Laser refractive surgery performed within the last 3
months;
Presence of chronic somatic diseases in the stage of
decompensation.
Control group 1 included 40 participants (80 eyes), 33
men (82.5%) and 7 women (17.5%), consisting of
civilians with DES symptoms, matched by age and sex
to ensure comparability with the main group.
Control group 2 included 40 participants (80 eyes), 32
men (80%) and 8 women (20%), consisting of healthy
civilians without DES symptoms, also matched by age
and sex to the main group.
The study employed general and specialized
ophthalmic examination methods.
The state of the meibomian glands (MG) was assessed
using the LacryDiag diagnostic system, which enables
high-resolution meibography and infrared imaging.
Participants underwent eyelid eversion with image
capture of the glands. The images were analyzed using
ImageJ software to determine MG density and classify
the degree of gland atrophy. The Meibomian Gland
Dysfunction Index (MGDI) was assessed based on a
visual scale evaluating secretion consistency and
quantity. An average dysfunction index was calculated
based on eight glands of the lower eyelid per eye. The
obtained numerical values were used for statistical
analysis of differences between the groups.
Normally, MGs present with uniform thickness, distinct
borders, and span the entire eyelid length. Mild
dysfunction was defined as slight shortening or
thinning of the glands with up to 25% area loss.
Moderate dysfunction was defined as a loss of 25
–
50%,
while severe dysfunction involved greater than 50%
gland structure loss, with glands appearing markedly
shortened or entirely absent.
Assessment of MGDI: The MGDI was based on clinical
signs of gland dysfunction and secretion function.
Eyelid margin features were evaluated: redness,
thickening, and signs of duct obstruction.
Secretory testing involved gentle compression of the
eyelids using a standard instrument (e.g., cotton stick
or other ophthalmic device).
The consistency of secretions was graded as follows:
Transparent fluid secretion: normal
Viscous, turbid, or absent secretion: dysfunction
Each gland was rated according to the following scale:
0
–
Normal (transparent fluid secretion)
1
–
Viscous or turbid secretion
2
–
No secretion
Eight glands of the lower eyelid were assessed per eye,
and the average score was calculated. The index was
computed as:
MGDI = (Sum of all gland scores) / (Number of glands
examined)
Classification of dysfunction severity:
0
–
0.5
–
Normal
0.6
–
1.0
–
Mild dysfunction
1.1
–
1.5
–
Moderate dysfunction
1.6
–
2.0
–
Severe dysfunction
Assessment of MG density was based on analysis of
meibography images using ImageJ software. Non-
functional zones were identified by absence,
shortening, or tortuosity of the glands.
The result was expressed as a percentage, reflecting
the proportion of preserved functional glands.
Density classification:
75%
–
Normal
50
–
75%
–
Mild atrophy
25
–
50%
–
Moderate atrophy
<25%
–
Severe atrophy
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Statistical analysis was performed using SPSS version
26.0. The Shapiro
–
Wilk test was used to assess the
normality of data distribution. Pearson’s correlation
coefficient was calculated to evaluate the relationship
between MGDI and the OSDI index. Statistical
significance was established at p<0.05.
RESULTS
Analysis of the distribution of eyes by the degree of
meibomian gland dysfunction (MGD) in the study
groups revealed significant differences among military
personnel with DES symptoms, civilians with symptoms
but not in military service, and healthy participants
(Figure 1).
Figure 1. Distribution of eyes (%) by the degree of meibomian gland dysfunction (MGD) in the study groups.
In the main group (military personnel, n=240), the most
common form was moderate MGD, observed in 41.7%
of cases, characterized by a 25
–
50% loss in gland area.
Mild dysfunction (loss of up to 25% gland area) was
present in 40.8% of eyes, and severe dysfunction (loss
of more than 50% gland area) was noted in 17.5% of
eyes, indicating pronounced changes in MG status. In
control group 1 (civilians with DES symptoms, n=80),
the distribution was more favorable: 45% of eyes had
mild dysfunction, 32.5% moderate, and 22.5% severe
dysfunction. Control group 2 (healthy participants,
n=80) showed the best outcomes: 70% of eyes
exhibited only mild dysfunction, and only 30%
demonstrated any signs of moderate or severe MGD,
possibly due to individual anatomical features. Analysis
of the average MG density in the study groups revealed
significant differences (Figure 2).
17.5
32.5
70
40.8
45
30
41.7
22.5
0
10
20
30
40
50
60
70
80
90
100
Main group (n=240)
Control group 1 (n=80)
Control group 2 (n=80)
Mild MGD (loss of up to 25% of gland area)
Moderate MGD (loss of 25–50% of gland area)
Severe MGD (loss of more than 50% of gland area)
25.6*^
51.4^
74.8
0
10
20
30
40
50
60
70
80
90
100
Main group (n=240)
Control group 1 (n=80)
Control group 2 (n=80)
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Figure 2. Average density (%) of meibomian glands in the study groups.
*
–
statistically significant differences compared to control group 1 at p<0.05
^
–
statistically significant differences compared to control group 2 at p<0.05
In the main group of military personnel, the average
MG density was 28.6%, indicating moderate atrophy
with 25
–
50% loss of gland area. This value was
significantly lower than that in both control group 1
(p<0.05) and control group 2 (p<0.05). In control group
1 (civilians with DES), average MG density was 51.4%,
consistent with mild atrophy (50
–
75%). Despite the
presence of DES symptoms, this value was significantly
higher than in the main group (p<0.05), indicating less
severe MG damage in civilians. However, the difference
from control group 2 was also statistically significant
(p<0.05).
Analysis of the Meibomian Gland Dysfunction Index
(MGDI), based on gland secretory function, revealed
that the average MGDI in the main group was
1.58±0.34 points, corresponding to moderate
dysfunction approaching the severe range (1.6
–
2.0).
This value was significantly higher than in control group
1
(1.22±0.22;
p<0.05),
indicating
moderate
dysfunction. Differences with control group 2
(0.48±0.11; p<0.05) were also statistically significant
and within the normal range (Table 1).
Table 1
Results of Meibomian Gland Dysfunction Index (MGDI) evaluation.
Group
MGDI (Mean ± SD)
Main group (n=240)
1.58±0.34*^
Control group 1 (n=80)
1.22±0.22^
Control group 2 (n=80)
0.48±0.11
*- – significant differences vs. control group 1 (p<0.05); ^ – significant differences vs. control group 2 (p<0.05)
Control group 1 exhibited a lower degree of MGD than
the main group; however, the average value of 1.22
points still indicates moderate dysfunction, confirming
the presence of pathology, albeit less pronounced than
in military personnel.
Thus, the observed differences demonstrate that
military personnel exhibit the most severe changes in
both MG density and function, which may contribute to
the development of DES and deterioration in quality of
life. It is noteworthy that MGD severity was more
pronounced than indicators of tear secretion,
highlighting the central role of MGD in the
pathogenesis and progression of DES in this population.
Correlation analysis between the OSDI index and MGDI
revealed a strong positive correlation in the main group
(r=0.701). This indicates a close association between
the severity of subjective symptoms and objective signs
of MGD. As MGD severity increases, so do subjective
complaints, underscoring the clinical importance of
MGD as a major factor in DES development among
military personnel.
Table 2
Correlation analysis between OSDI index and MGDI.
Group
Correlation with OSDI (r)
Main group (n=240)
0.701
Control group 1 (n=80)
0.524
Control group 2 (n=80)
0.116
In control group 1 (civilians with DES), a moderate
positive correlation was observed (r=0.524), suggesting
that subjective complaints were also related to MGD
severity, though to a lesser degree than in military
personnel. In control group 2, the correlation between
the OSDI index and MGDI was weak and statistically
insignificant (r=0.116).
The findings indicate that both the main group and
control group 1 exhibit a significant relationship
between MGD severity and patient complaints. The
strongest correlation was found among military
personnel, emphasizing the need for a comprehensive
approach to diagnosing and managing DES in this
population.
DISCUSSION
The results demonstrated a significantly more severe
degree of meibomian gland dysfunction (MGD) in
military personnel compared to the control groups. The
average MG density in the main group was 28.6%,
corresponding to moderate atrophy, whereas in
control group 1 this value reached 51.4%, and in the
healthy control group exceeded 70%. These findings
indicate statistically significant differences between the
main and control groups (p<0.05).
International Journal of Medical Sciences And Clinical Research
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
Significant differences were also observed in the
Meibomian Gland Dysfunction Index (MGDI). Among
military personnel, the average MGDI was 1.58±0.34
points, approaching the threshold for severe
dysfunction. In contrast, the value in control group 1
was lower at 1.22±0.22 points, and in control group 2 it
was 0.48±0.11 points, consistent with normal function.
Particular attention should be given to the strong
positive correlation observed between symptom
severity (OSDI index) and MGDI in the military group
(r=0.701), indicating a direct relationship between
subjective complaints and objective signs of MGD.
Among civilians with DES symptoms, this relationship
was less pronounced (r=0.524), and among healthy
participants it was virtually absent (r=0.116).
Thus, MGD in military personnel manifests more
severely in both anatomical and functional dimensions.
This highlights the need for a specialized approach to
the diagnosis and prevention of DES in the military
environment, including regular ophthalmological
monitoring and the use of advanced diagnostic
technologies such as LacryDiag.
CONCLUSION
The data obtained indicate significantly more
pronounced meibomian gland dysfunction in military
personnel with DES symptoms compared to civilian
individuals, as evidenced by both morphological (MG
density of 28.6%) and functional (MGDI 1.58±0.34)
parameters. The application of the LacryDiag method
demonstrated high clinical relevance in the diagnosis of
MGD.
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