Morphologic changes in the MGs shown by LSCM were interpreted as signs of MG dropout, duct obstruction, and glandular inflammation. A comprehensive LSCM evaluation of the ocular surface in CLWs could better clarify the role of MG dropout and eyelid margin inflammation on the pathogenesis of CL-induced dry eye.

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Purpose: To evaluate the postoperative effects of topical coenzyme Q₁₀ + vitamin E d-α-tocopheryl polyethylene glycol 1000 succinate (CoQ₁₀) aftercataract surgery. Methods: 40 consecutive patients were randomized to receive CoQ₁₀ or saline solution (SS) twice daily for 9 months after uneventful cataract surgery with a temporal port. Before surgery, on day 14 and at months 3, 6 and 9, they underwent non-invasive break-up time (NIBUT) testing, Schirmer test, BUT, aesthesiometry as well as in vivo confocal microscopy of the subbasal nerve plexus of the cornea (SBP). The density of the subbasal nerves was calculated in the central (CFD) and temporal (TFD) cornea (number of fibres per field). Results: On day 14, surgery reduced CFD and TFD, respectively, by 25–35 and 50%; indices of ocular surface stability were all impaired. The treatment with CoQ₁₀ was associated with faster nerve regeneration than SS (at month 3, CFD +1.5 ± 1.9 vs. +0.2 ± 1.8, p = 0.04, and TFD +2.5 ± 1.7 vs. +1.0 ± 1.6, p = 0.007; at month 6, TFD +2.7 ± 1.9 vs. +1.4 ± 1.5, p = 0.02) and better stability of ocular surface (NIBUT and BUT) throughout the study. No relevant side effects were found, apart from occasional burning in 10% of CoQ₁₀ patients. Conclusions: Changes of the corneal nerves occurring after cataract surgery may influence the integrity of the ocular surface. Treatment with topical CoQ₁₀ has a positive effect in restoring SBP anatomy and ocular surface stability.