Prevalence of Meibomian Gland Dysfunction in Patients with Keratoconus in an Optometry Clinic in the Palestinian Authority

<b>Background/Objectives:</b> Meibomian gland dysfunction (MGD) has been shown to be more prevalent in patients with keratoconus (KC) in Turkey, Egypt, and Israel but has not been examined in the Palestinian Authority (PA). Therefore, this study compared the prevalence and clinical features of MGD in patients with keratoconus versus healthy controls seen in an optometry clinic in the PA. <b>Methods:</b> Patients with KC and healthy controls who were non-contact lens wearers were recruited. Habitual visual acuity (VA), tear break-up time (TBUT), meibography, meibomian gland (MG) expressibility (MES) and quality score (MQS), and Schirmer test were evaluated. MGD was defined by an Ocular Surface Disease Index (OSDI) Questionnaire score ≥ 13, TBUT < 10 s, and MG loss > Grade 1. Outcomes were compared using Mann-Whitney U tests, Chi-Square tests and Spearman correlation. <b>Results:</b> The study included 33 eyes of 17 KC (mean age: 29.2 ± 7.7, range:19-50) and 27 right eyes of 27 control participants (mean age: 34.2 ± 11.7, range:18-56). MGD was prevalent in 67% of KC and 30% of control participants. VA was significantly worse (0.8 + 0.2 vs. 1.0 + 0.0, <i>p</i> < 0.001), with significantly greater MG loss in the lower eyelids (<i>p</i> = 0.002), and shorter TBUT (4.1 ± 1.5 s vs. 5.7 ± 1.7 s, <i>p</i> < 0.001) in the KC group. No significant differences were found in symptoms, MES, MQS, MG loss in the upper eyelids, or Schirmer test. <b>Conclusions:</b> KC patients exhibited a significantly higher prevalence and severity of MGD signs compared with controls. These findings highlight the importance of comprehensive ocular surface evaluation and management in this population.