Evaluation of the Ocular Surface and Meibomian Gland in Obstructive Sleep Apnea Hypopnea Syndrome

Abstract

PurposeTo assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG.MethodsBased on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. In addition, detailed Ophthalmic examination including visual acuity, refraction, slit-lamp examination of the anterior segment, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) scoring, Schirmer I test (SIT) and serum lipid measurement was performed. For OSAHS patients with dry eye syndrome (DES) who underwent uvulopalatopharyngoplasty for improving AHI, the conditions of the ocular surface and MG were compared before surgery and 3 months after surgery. Only the data of the right eyes were analyzed.ResultsThere were no significantly different in the OSDI score, tear meniscus height (TMH), or loss ratio of the lower eyelid (LRLE) among these groups. The first non-invasive tear film breakup time (fNIBUT), average non-invasive tear film breakup time (avNIBUT), bulbar redness index (BRI), lipid layer grading (LLG), CFS, plugged orifices and distortion in MG, the loss ratio of upper eyelid (LRUE), and the incidence of DES, floppy eyelid syndrome (FES) and meibomian gland dysfunction (MGD) showed significant differences between Groups A and C (p = 0.015, p = 0.018, p < 0.001, p = 0.022, p = 0.036, p = 0.007, p = 0.019, p = 0.017, p = 0.045, p = 0.013, and p = 0.029, respectively). The SIT in the Group A was significantly higher than in Group B (p = 0.025) and in Group C (p < 0.001). In the correlation analyses, the fNIBUT, avNIBUT, SIT and LLG had negative correlations with the AHI (p = 0.013, p = 0.010, p = 0.003, p < 0.001, and p = 0.006, respectively). The BRI, CFS and LRUE were positively correlated with the AHI (p = 0.006, p = 0.007, and p = 0.046, respectively). Three months after surgery, there were no significant differences in the ocular surface or MG.ConclusionPatients with severe OSAHS have poor stability of tear film and are prone to lipid-deficient dry eye as a result of the loss of meibomian gland. By improving the AHI, the ocular surface damage of OSAHS patients cannot be reversed in a short time.

Altered Intrinsic Regional Spontaneous Brain Activity in Patients With Severe Obesity and Meibomian Gland Dysfunction: A Resting-State Functional Magnetic Resonance Imaging Study

“…Long term chronic intermittent hypoxia in patients with OSAHS will cause chronic inflammatory response and immune changes ( Maniaci et al, 2021 ). Long term hypoxia and persistent inflammation lead to apoptosis of goblet cells and keratoconjunctival epithelial cells on the ocular surface and damage the ocular surface ( Liu et al, 2022 ). In addition, this long-term intermittent hypoxia can not only directly damage the MG, but also indirectly cause MGD by causing the increase of matrix metalloproteinase, the decrease of elastic fibers and the relaxation of eyelids ( Reins et al, 2018 ; Liu et al, 2022 ).…”

“…Long term hypoxia and persistent inflammation lead to apoptosis of goblet cells and keratoconjunctival epithelial cells on the ocular surface and damage the ocular surface ( Liu et al, 2022 ). In addition, this long-term intermittent hypoxia can not only directly damage the MG, but also indirectly cause MGD by causing the increase of matrix metalloproteinase, the decrease of elastic fibers and the relaxation of eyelids ( Reins et al, 2018 ; Liu et al, 2022 ). The mechanism is that the MG cannot excrete normally due to the loss of eyelid support and extrusion, and MG obstruction develops into MGD ( Pihlblad and Schaefer, 2013 ).…”

Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology

“…There are various studies in the literature about ocular findings in patients with OSAS, especially in the last quarter century. 6,8,[12][13][14][15] These studies have mostly focused on the ocular surface, eyelids, and dry eye, and results on conjunctival cytology are extremely limited. 7,16 Among these studies, Acar et al 12 reported that they detected low Schirmer and TBUT values and high OSDI scores in moderate and severe OSAS cases.…”

“…The most interesting of these findings are floppy eyelid syndrome and meibomian gland disease. [6][7][8] Conjunctival impression cytology (CIC) is a safe and noninvasive method used to evaluate changes in conjunctival epithelial cells. Nuclear, morphological and cytoplasmic features of conjunctival epithelial cells and goblet cell density can be evaluated with this method.…”

Dry eye disease and tear film assessment through a novel non-invasive ocular surface analyzer: The OSA protocol

“…In addition, OSA Plus and IDRA perform automatic 3D meibography. Using Keratograph 5M, the analysis can be subjective by comparing the image obtained with a reference scale with four degrees (ranging from 0 to 3) ( 13 , 45 , 46 ) or semiautomatic through the ImageJ software that provides the total area analyzed and the area covered by MGs ( 47 , 60 , 63 , 64 ). The advantage that OSA presents with respect to the rest of dry eye analyzers is that the measurement of the MGD percentage is carried out automatically and objectively.…”