Quantitative infrared meibography for ocular rosacea: lower eyelid meibomian gland loss as a diagnostic marker

To quantitatively assess meibomian gland loss (MGL) using infrared meibography in patients with ocular rosacea and to evaluate its diagnostic performance and relationship with ocular surface parameters. Thirty eyes from 30 patients with ocular rosacea and 34 eyes from 34 controls were analyzed. The Ocular Surface Disease Index (OSDI), Schirmer I test (without anesthesia), Oxford staining, and non-invasive tear break-up time (NITBUT) were recorded. Infrared meibography (Sirius system) quantified MGL in both upper and lower eyelids. Receiver operating characteristic (ROC) curve and logistic regression analyses were performed. Meibomian gland loss was significantly higher in both upper (31.4 ± 13.8% vs. 20.0 ± 7.3%) and lower (46.0 ± 12.5% vs. 18.4 ± 9.6%) eyelids of patients compared with controls (both p < 0.001). ROC analysis showed excellent diagnostic accuracy for lower-lid MGL (AUC = 0.97, 95% CI: 0.93–1.00; p < 0.001) with an optimal cut-off of 30.2%, yielding 100% sensitivity and 91% specificity, whereas upper-lid MGL showed moderate accuracy (AUC = 0.77, 95% CI: 0.62–0.91). Lower-lid MGL showed a strong correlation with NITBUT (r = − 0.63) and modest but significant correlations with OSDI (r = 0.32) and Oxford staining (r = 0.29; all p < 0.05). Ocular rosacea is associated with marked meibomian gland dropout in both eyelids, with the lower lid showing superior diagnostic performance. Quantitative infrared meibography provides an objective and practical tool for assessing gland involvement in ocular rosacea.