Infrared Auto Refractor Based Evaluation of Meibomian Gland Morphology, Its Correlation with Tear Film Parameters in Patients with Dry Eye Disease

Background: Dry eye disease (DED) is a prevalent ocular surface disorder causing symptoms of watering, redness of eyes, ocular discomfort, visual disturbance, and signs of congestion, reduced tear meniscus, particulate debris in the tear film, changes in the meibomian gland number and morphology, and increased tear osmolarity. Conventional meibography offers detailed imaging of Meibomian glands but remains costly and unavailable in routine practice. This study evaluated gland morphology using a standard infra red autorefractor with an infra red imaging device and correlated findings with tear-film parameters. Methods: In this cross-sectional study, 106 patients who met the inclusion, exclusion criteria with clinically diagnosed DED were examined at a tertiary care center. Each participant underwent Schirmer’s II test and tear break-up time (TBUT) measurement. Meibomian gland morphology was imaged using the infrared module of the AR-UNIQUE.RK auto-refractometer. Parameters such as acini visibility, main duct exposure, orifice morphology, and lid margin irregularities were graded and correlated with tear-film indices using Spearman’s correlation and non-parametric tests (p < 0.05 significant). Results: Poor or moderate acini visibility (Grades 2–3) was observed in 75.5% of patients, and orifice abnormalities in 68%. Mean Schirmer’s values were 7.7 ± 1.9 mm (RE) and 7.4 ± 1.8 mm (LE), while mean TBUT was 6.4 ± 1.6 s and 6.2 ± 1.5 s, respectively. Acini visibility grade correlated negatively with Schirmer’s (r = –0.42, p < 0.001) and TBUT (r = –0.39, p = 0.002). Increased morphological severity was significantly associated with reduced tear-film stability (p < 0.001). Conclusion: Infrared imaging using an auto refractometer effectively identified Meibomian gland abnormalities correlating with functional tear film deficits. This approach provides a practical, low cost alternative for early detection of Meibomian gland dysfunction in resource limited ophthalmic settings.