Abstract:

Objective To analyze the mental status of patients with meibomian gland dysfunction (MGD) and its relationship with clinical parameters of ocular surface. Design Cross-sectional study. Participants 923 MGD patients and 114 controls. Methods All subjects were required to complete the Ocular Surface Disease Index (OSDI),  Modified-self-rating depression scale(M-SDS) questionnaire and 6 items of objective ocular surface examinations including TBUT, corneal fluorescein (FL) staining,  Schirmer I test(SIt),  meibomian gland loss rate (measured by meibomian gland infrared photography and ImageJ software),  lipid layer thickness (LLT)(measured  by LipiView ocular surface interferometer) and meibomian gland yielding secretion score (MGYSS)(measured by applying a constant pressure to the meibomian glands via a meibomian gland evaluator). The correlation between M-SDS and OSDI and ocular objective examination results of MGD patients was analyzed. Main Outcome Measures OSDI,  M-SDS,  TBUT,  FL, SIt,  meibomian gland loss rate,  LLT,  MGYSS. Results The OSDI of MGD group (33.88 ± 16.13) was higher than that of the control group (13.63 ± 8.91) (t=20.47,  P<0.001). The average TBUT in MGD group was significantly lower than that in control group (4.16±2.30 vs 7.28±4.17,  t=-7.84,  P<0.001). The average FL in MGD group was significantly higher (0.72±1.21 vs 0.23±0.64,  t= 6.91,  P<0.001). The SIt(10.07±8.05) mm has no significant difference compared to the control group (10.18±8.06) (t=-0.14,  P=0.89). Meibomian gland loss rate(14.33±12.23)% was higher than that of the control group (8.25±10.31)% (t=5.19，P<0.001). LLT (62.02±24.79) was lower than that of the control group (67.45±21.58) (t=-2.24,  P=0.03). MGYSS (9.06±7.12) was lower than the control group (15.61±10.76) (t=-6.33,  P <0.001). The average score of M-SDS in MGD group (37.91±9.48) was higher than that in control group (31.96±7.82) (t=6.42,  P=0.001). Among 923 patients in MGD group,  the M-SDS scores of youth and middle-age groups were higher than the elderly group (F=6.414,  P=0.002). Correlation test showed M-SDS was positively correlated with OSDI,  but negatively correlated with age. Multivariate linear regression analysis showed,  the odds of depression in MGD group were higher than control group (OR=2.789,  95 % CI:  1.004~7.553) (χ2= 4.121,  P=0.042).  Among the 85 depressed patients in the MGD group,  the most severe symptoms of depression were:  fear of blindness,  loss of appetite,  feeling useless,  confusion and lack of interest. Conclusion Patients with MGD are more susceptible to depression,  which may be related to the effect of MGD symptoms on mental status. The youth and middle-aged MGD patients had higher prevalence of depression compared with senile MDG patients.（Ophthalmol CHN,  2018, 27：129-134）

Key words: meibomian gland dysfunction, depression, correlation analysis