Ocular Surface Changes and Meibomian Gland Dysfunction in Rheumatologic Patients

Ocular Surface Changes and Meibomian Gland Dysfunction in Rheumatologic Patients: A Cross-Sectional Analytical Study

This observational study aims to assess the frequency and severity of Meibomian Gland Dysfunction (MGD) and associated ocular surface changes in patients with systemic autoimmune rheumatic diseases compared with healthy volunteers.

Meibomian glands are specialized glands in the eyelids that produce the lipid layer of tears, preventing tear evaporation. Systemic inflammation in rheumatologic conditions may affect these glands, leading to dry eye symptoms and ocular surface damage.

A total of 150 participants (120 rheumatologic patients and 30 healthy controls) will be evaluated in a single cross-sectional examination. Rheumatologic diagnoses include Rheumatoid Arthritis, Systemic Lupus Erythematosus, Sjogren's Syndrome, Ankylosing Spondylitis, and Psoriatic Arthritis.

Participants will undergo a standardized series of non-invasive and minimally invasive eye examinations, including:

• An ocular symptom questionnaire (Ocular Surface Disease Index)
• Non-contact infrared meibography to assess meibomian gland loss (Meiboscore)
• Non-invasive tear break-up time (NIBUT) and tear meniscus height measurements
• Slit-lamp biomicroscopy and corneal fluorescein staining

The study also examines how meibomian gland alterations correlate with systemic disease activity scores and inflammatory blood markers.

Inclusion Criteria:

• Age 18 years or older
• Ability to provide written informed consent
• For rheumatologic patients: Confirmed clinical diagnosis of one of the following autoimmune diseases:
• Rheumatoid Arthritis (2010 ACR/EULAR classification criteria)
• Systemic Lupus Erythematosus (2019 EULAR/ACR classification criteria)
• Sjogren's Syndrome (2016 ACR/EULAR classification criteria)
• Ankylosing Spondylitis (modified New York criteria)
• Psoriatic Arthritis (CASPAR criteria)
• For healthy controls: Age- and sex-matched individuals with no systemic autoimmune disease and no current ocular surface complaints

Exclusion Criteria:

• Chronic use of topical antiglaucoma eye drops
• Ocular surgery within the past 6 months
• Active ocular infection or active uveitis
• Contact lens wearers who have not discontinued wear for at least 2 weeks
• History of ocular chemical burns
• Pregnancy or lactation
• Incomplete rheumatologic records or missing essential laboratory data