Meibomian gland dysfunction (MGD) is one of the most common causes of evaporative dry eye disease and represents a major contributor to ocular surface morbidity worldwide. It is characterized by terminal duct obstruction and/or qualitative or quantitative changes in glandular secretions, leading to tear film instability, ocular surface inflammation, and symptoms of eye irritation and visual fluctuation (1). The global prevalence of MGD varies considerably across studies, ranging from 30% to 60% in the general population, with the condition being more frequent and severe among Asian populations than Caucasians (2). The meibomian glands are specialized sebaceous glands located in the tarsal plates of the eyelids and are responsible for secreting the lipid component of the tear film, which minimizes tear evaporation and maintains ocular surface integrity (3). Dysfunction of these glands results in a compromised lipid layer, excessive tear evaporation, and eventual development of evaporative dry eye (4). The pathogenesis of MGD is multifactorial, involving aging, hormonal imbalance, environmental factors, and systemic conditions that influence lipid metabolism. Because meibomian gland secretions are lipid-rich, it is biologically plausible that systemic lipid abnormalities may influence the composition, viscosity, and melting point of meibum. Dyslipidemia—defined as abnormal levels of serum lipids including elevated total cholesterol, triglycerides, or low-density lipoprotein (LDL), and/or reduced high-density lipoprotein (HDL)—is a well-established risk factor for cardiovascular diseases (5). Recent global studies have shown a possible link between dyslipidemia and MGD, with patients exhibiting higher total cholesterol and LDL levels, and altered lipid profiles associated with increasing clinical severity of MGD (6). In the Indian context, MGD has been reported to have a prevalence of approximately 55–60%, making it one of the most common eyelid disorders encountered in ophthalmology outpatient settings (7). Lifestyle changes, increasing screen exposure, and dietary habits may contribute to the rising incidence of both MGD and dyslipidemia in the Indian population. Studies from India have also demonstrated a positive correlation between elevated serum lipids—particularly triglycerides and total cholesterol—and the clinical severity of MGD, emphasizing the need for integrated ocular and systemic assessment. Despite this growing evidence, limited data exist on the correlation between clinical grading of MGD and lipid profile abnormalities in the South Indian population. Understanding this relationship could help ophthalmologists in early identification of patients at risk for systemic dyslipidemia, allowing for timely referral and potential therapeutic interventions that address both ocular and systemic components of the disease. Aim and Objectives Aim To study the association between clinical grades of Meibomian Gland Dysfunction (MGD) and dyslipidemia. Objectives 1. To find the relationship between different clinical grades of MGD and serum lipid profile levels. 2. To identify whether higher grades of MGD are associated with increased prevalence of dyslipidemia.

Study Design and Setting A cross-sectional observational study was conducted at Sankara Eye Hospital, Shimoga, from August 2019 to October 2020. Study Population A total of 115 patients clinically diagnosed with Meibomian Gland Dysfunction (MGD) were included in the study. Inclusion Criteria • Patients aged above 18 years. • Clinically diagnosed cases of MGD. Exclusion Criteria • Patients with infectious keratoconjunctivitis or ocular surface inflammation unrelated to MGD. • History of ocular surgery within the last six months. • Use of topical ophthalmic steroids or anti-glaucoma medications. • Patients on systemic drugs affecting lipid metabolism. • Known cases of systemic diseases such as Sjögren’s syndrome, rosacea, or liver disease. Data Collection After obtaining informed consent, demographic and clinical data were recorded. Ocular examination included slit-lamp evaluation of lids and meibomian glands. MGD was graded clinically as follows: • Grade 0: Clear fluid on mild pressure • Grade 1: Clear fluid on firm pressure • Grade 2: Cloudy fluid on firm pressure • Grade 3: Inspissated or no secretion on firm pressure Lipid Profile Estimation Venous blood samples were collected after overnight fasting. Serum total cholesterol, triglycerides, HDL, LDL, and VLDL were measured. Dyslipidemia was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria: • Total cholesterol ≥200 mg/dL • Triglycerides ≥150 mg/dL • LDL ≥130 mg/dL • HDL <40 mg/dL (men) or <50 mg/dL (women) • VLDL ≥30 mg/dL Statistical Analysis Data were analyzed using SPSS. Categorical variables were expressed as percentages, and associations between MGD grades and lipid parameters were tested using the Chi-square test. A p-value ≤0.05 was considered statistically significant.

A total of 115 patients diagnosed with Meibomian Gland Dysfunction (MGD) were included in the study. The mean age was 60.3 ± 10.4 years, with 70.4% males and 29.6% females. The majority of patients were between 61–70 years (36.5%). Table 1. Distribution of Study Population According to Clinical Grades of MGD MGD Clinical Grade Number of Patients (n=115) Percentage (%) Grade 0 14 12.17 Grade 1 23 20.00 Grade 2 37 32.17 Grade 3 41 35.65 Total 115 100.00 Observation: Most patients had moderate to severe MGD (Grades 2 and 3). Fig 1. Distribution of Study Population According to Clinical Grades of MGD Table 2. Lipid Profile of the Study Population Parameter Mean ± SD (mg/dL) Median Range Total Cholesterol 176.34 ± 28.30 169.00 114–241 Triglycerides 100.41 ± 26.06 98.00 42–208 HDL 40.52 ± 7.69 40.00 30–102 LDL 66.43 ± 9.88 68.00 40–82 VLDL 24.35 ± 5.56 23.00 19–72 Observation: Mean total cholesterol and HDL were near normal limits in most patients. Table 3. Association between Total Cholesterol and MGD Clinical Grades Total Cholesterol (mg/dL) Grade 0 Grade 1 Grade 2 Grade 3 Total p-value <200 10 (12.2%) 22 (26.8%) 26 (31.7%) 24 (29.3%) 82 (71.3%) 0.010 ≥200 4 (12.1%) 1 (3.0%) 11 (33.3%) 17 (51.5%) 33 (28.7%) Total 14 23 37 41 115 Interpretation: Higher total cholesterol levels were significantly associated with Grade 3 MGD (p = 0.010). Fig 2: Association between Total Cholesterol and MGD Clinical Grades Table 4. Association between Triglycerides and MGD Clinical Grades Triglycerides (mg/dL) Grade 0 Grade 1 Grade 2 Grade 3 Total p-value <150 14 (12.6%) 23 (20.7%) 34 (30.6%) 40 (36.0%) 111 (96.5%) 0.281 ≥150 0 (0%) 0 (0%) 3 (75.0%) 1 (25.0%) 4 (3.5%) Total 14 23 37 41 115 Interpretation: Elevated triglyceride levels were not significantly associated with MGD grade. Table 5. Association between HDL and MGD Clinical Grades HDL (mg/dL) Grade 0 Grade 1 Grade 2 Grade 3 Total p-value <40 7 (14.6%) 14 (29.2%) 16 (33.3%) 11 (22.9%) 48 (41.7%) 0.281 ≥40 7 (10.4%) 9 (13.4%) 21 (31.3%) 30 (44.8%) 67 (58.3%) Total 14 23 37 41 115 Interpretation: No significant association was found between HDL levels and MGD severity. Table 6. Association between VLDL and MGD Clinical Grades VLDL (mg/dL) Grade 0 Grade 1 Grade 2 Grade 3 Total p-value <30 13 (12.3%) 22 (20.7%) 34 (32.1%) 37 (34.9%) 106 (92.2%) 0.898 ≥30 1 (11.1%) 1 (11.1%) 3 (33.3%) 4 (44.4%) 9 (7.8%) Total 14 23 37 41 115 Interpretation: No significant relationship was observed between VLDL and MGD grade. Summary of Findings • Significant association was found between total cholesterol and MGD severity (p = 0.010). • Other lipid parameters (TG, HDL, VLDL) showed no significant correlation with MGD grades. • Higher grades of MGD were more common in elderly patients and those with raised cholesterol.

In the present study, an attempt was made to evaluate the association between clinical grades of Meibomian Gland Dysfunction (MGD) and serum lipid profile abnormalities. A significant correlation was found between higher grades of MGD and elevated total cholesterol levels (p = 0.010), suggesting that dyslipidaemia, particularly hypercholesterolemia, may play a contributory role in the pathogenesis or progression of MGD. MGD is a chronic, diffuse disorder of the meibomian glands characterized by obstruction and altered secretion, leading to tear film instability and evaporative dry eye (8). The lipid-rich nature of meibomian secretions makes it biologically plausible that systemic lipid abnormalities could influence glandular function and composition (9). Increased cholesterol and saturated lipids in meibum can raise its melting point and viscosity, promoting ductal blockage and meibomian gland dropout (10). The findings of the present study are consistent with those reported by Dao et al. (2010), who demonstrated that patients with moderate to severe MGD had a higher prevalence of dyslipidemia compared to the general population (11). Similarly, Bukhari et al. (2013) observed that the severity of MGD was positively correlated with elevated serum triglyceride and LDL levels, indicating that worsening MGD could be associated with lipid abnormalities (12). In another Indian study, Guliani et al. (2018) reported that total cholesterol, triglycerides, and LDL increased significantly with MGD severity, reinforcing the metabolic link between ocular and systemic lipid dysregulation (13). The present findings also resonate with Banait and Hada (2019), who demonstrated a strong correlation between higher MGD stages and increased total cholesterol and LDL levels (14). The mechanism underlying this association could be multifactorial, involving altered lipid synthesis, inflammation, and oxidative stress. Dyslipidemia can alter the biochemical properties of meibum, leading to hyperviscous secretions that obstruct gland ducts. This obstruction further perpetuates a cycle of stasis, gland dropout, and tear film instability. In contrast, some studies such as Pinna et al. (2013) have reported that patients with MGD had elevated total cholesterol but relatively normal triglyceride and HDL levels, suggesting that not all lipid parameters are equally involved in disease progression (9). The present study similarly found no significant association between MGD grades and triglycerides, HDL, or VLDL, implying that total cholesterol may be the most sensitive systemic indicator in these patients. The clinical relevance of these findings lies in the possibility that MGD may serve as an ocular marker for underlying dyslipidemia, especially in asymptomatic individuals. Early detection of lipid abnormalities in patients presenting with chronic blepharitis or evaporative dry eye could allow timely lifestyle or pharmacologic interventions to prevent systemic complications.

This study demonstrated a significant association between higher clinical grades of Meibomian Gland Dysfunction (MGD) and elevated total cholesterol levels, suggesting that dyslipidemia, particularly hypercholesterolemia, may contribute to the severity of MGD. Other lipid parameters such as triglycerides, HDL, and VLDL did not show a significant correlation. These findings highlight the importance of evaluating serum lipid profiles in patients with moderate to severe MGD. Early detection and management of dyslipidemia may not only improve ocular surface health but also help in preventing systemic cardiovascular risks.

1. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, et al. The International Workshop on Meibomian Gland Dysfunction: Executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922–1929. 2. Arita R, Fukuoka S, Morishige N. New insights into the pathophysiology of meibomian gland dysfunction. Exp Eye Res. 2017;163:64–71. 3. Knop E, Knop N, Millar T, Obata H, Sullivan DA. The International Workshop on Meibomian Gland Dysfunction: Report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci. 2011;52(4):1938–1978. 4. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276–283. 5. National Cholesterol Education Program (NCEP). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–2497. 6. Bukhari AA. Associations between dyslipidemia and meibomian gland dysfunction in a Saudi population. Int Ophthalmol. 2013;33(6):599–605. 7. Guliani BP, Bhalla A, Naik MP, Phuljhele S, Raj S, Sihota R. Correlation of severity of meibomian gland dysfunction with serum lipoproteins in Indian patients. Int J Ophthalmol. 2018;11(4):610–615. 8. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, et al. The International Workshop on Meibomian Gland Dysfunction: Executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922–1929. 9. Pinna A, Blasetti F, Zinellu A, Carru C, Solinas G, Meibomian gland dysfunction and hypercholesterolemia. Br J Ophthalmol. 2013;97(3):301–304. 10. Knop E, Knop N, Millar T, Obata H, Sullivan DA. The International Workshop on Meibomian Gland Dysfunction: Report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci. 2011;52(4):1938–1978. 11. Dao AH, Spindle JD, Harp BA, Jacob A, Chung EH. Association of dyslipidemia in moderate to severe meibomian gland dysfunction. Am J Ophthalmol. 2010;150(3):371–375. 12. Bukhari AA. Associations between dyslipidemia and meibomian gland dysfunction in a Saudi population. Int Ophthalmol. 2013;33(6):599–605. 13. Guliani BP, Bhalla A, Naik MP, Phuljhele S, Raj S, Sihota R. Correlation of severity of meibomian gland dysfunction with serum lipoproteins in Indian patients. Int J Ophthalmol. 2018;11(4):610–615. 14. Banait S, Hada Y. Association between dyslipidemia and Meibomian gland dysfunction in adults. Indian J Clin Exp Ophthalmol. 2019;5(3):345–349.