{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:43:25Z","timestamp":1790700205292,"version":"4.1.0"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Meibomian gland dysfunction (MGD) secondary to thyroid-associated ophthalmopathy (TAO) represents a significant pathogenic mechanism in dry eye disease. This study provides the first systematic review and meta-analysis of MGD indicators in TAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The study protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (Registration ID: CRD420251020327) before data extraction. Following PRISMA and MOOSE guidelines, a systematic search was conducted across PubMed, Embase, Web of Science, Scopus, Ovid Medline, and Cochrane from inception through March 27, 2025. Fourteen studies met the inclusion criteria. Key indicators included lipid layer thickness (LLT), meiboscore, meibum quality, first non-invasive tear film break-up time (NITBUT-f), average non-invasive tear film break-up time (NITBUT-avg), tear break-up time (TBUT), meibomian gland dropout area in the upper (MGDU) and lower eyelids (MGDL), and\n                      <jats:italic>in vivo<\/jats:italic>\n                      confocal microscopy (IVCM) markers (meibomian gland acinar density [MAD], meibomian gland acinar longest diameter [MALD], meibomian gland acinar shortest diameter [MASD]). Risk of bias was assessed using the AHRQ checklist or NOS. Meta-analysis was performed with Review Manager 5.4.1 and Stata 16.0. Publication bias was assessed using Egger's test and funnel plots. Fixed-effects models were used in the absence of significant heterogeneity (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;gt; 0.10 or\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      &amp;lt; 50%); otherwise, random-effects models were applied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen studies (813 TAO eyes, 522 controls) were included in the meta-analysis. Quality assessment revealed moderate-to-high methodological rigor across studies. Patients with TAO exhibited significantly worse meibomian gland indicators compared to controls: shorter tear film stability (NITBUT-f, TBUT), higher LLT, increased meiboscore and greater eyelid gland dropout (MGDU, MGDL). IVCM markers indicated meibomian acinar enlargement (MALD, MASD). Significant heterogeneity was observed in several outcomes, including NITBUT-f, NITBUT-avg, meiboscore, Meibum quality, TBUT and MGDU comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the limited number of studies and small sample sizes, TAO is linked to meibomian gland atrophy, acinar dilation, and tear film instability. Active disease is associated with more pronounced lipid layer abnormalities. Targeted evaluation and management of MGD are crucial to mitigate TAO-associated ocular surface morbidity and improve patient quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1709057","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T06:32:27Z","timestamp":1762842747000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Meibomian gland dysfunction in patients with thyroid-associated ophthalmopathy: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Yanling","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongran","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1089\/thy.2007.0407","article-title":"Immune mechanisms in thyroid eye disease","volume":"18","author":"Lehmann","year":"2008","journal-title":"Thyroid."},{"key":"B2","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1097\/ACI.0b013e32833e1749","article-title":"The ocular surface in thyroid diseases","volume":"10","author":"Versura","year":"2010","journal-title":"Curr Opin Allergy Clin Immunol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1038\/s41433-018-0279-9","article-title":"The involvement of T cell pathogenesis in thyroid-associated ophthalmopathy","volume":"33","author":"Huang","year":"2019","journal-title":"Eye."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1217253","DOI":"10.3389\/fphar.2023.1217253","article-title":"Current and promising therapies based on the pathogenesis of Graves' ophthalmopathy","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Pharmacol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"372","DOI":"10.3109\/08820538.2013.874491","article-title":"Dry Eye Syndrome in Non-Exophthalmic Graves' Disease","volume":"30","author":"Bruscolini","year":"2015","journal-title":"Semi. Ophthalmol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3109\/02713683.2010.526285","article-title":"Ocular surface and dry eye in Graves' disease","volume":"36","author":"G\u00fcrdal","year":"2011","journal-title":"Curr Eye Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1111\/ceo.14208","article-title":"Change in lacrimal gland volume and aqueous tear production following treatment with teprotumumab","volume":"51","author":"Ugradar","year":"2023","journal-title":"Clin Exp Ophthalmol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1111\/j.1395-3907.2004.00268.x","article-title":"Dry eye syndrome in thyroid-associated ophthalmopathy: lacrimal expression of TSH receptor suggests involvement of TSHR-specific autoantibodies","volume":"82","author":"Eckstein","year":"2004","journal-title":"Acta ophthalmologica Scandinavica"},{"key":"B9","doi-asserted-by":"publisher","first-page":"10792","DOI":"10.1038\/s41598-018-29113-2","article-title":"Differential profiling of lacrimal cytokines in patients suffering from thyroid-associated orbitopathy","volume":"8","author":"Kishazi","year":"2018","journal-title":"Sci. Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"6299","DOI":"10.1002\/jcb.27916","article-title":"The expression of interleukin-15 and interleukin-17 in tears and orbital tissues of Graves ophthalmopathy patients","volume":"120","author":"Chen","year":"2019","journal-title":"J Cell Biochemist"},{"key":"B11","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3760\/cma.j.cn112142-20240319-00120","article-title":"Research advances in the pathogenesis of dry eye in thyroid associated ophthalmopathy","volume":"61","author":"Ma","year":"2025","journal-title":"[Zhonghua yan ke za zhi] Chin J Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e18242","DOI":"10.1097\/MD.0000000000018242","article-title":"Efficacy and safety of tripterygium glycosides for Graves ophthalmopathy: a systematic review and meta-analysis","volume":"98","author":"Liu","year":"2019","journal-title":"Medicine."},{"key":"B13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jtos.2022.02.001","article-title":"Ocular surface disease in thyroid eye disease: a narrative review","volume":"24","author":"Rana","year":"2022","journal-title":"Ocular Surface."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1420","DOI":"10.4103\/IJO.IJO_2823_22","article-title":"A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions","volume":"71","author":"Geethika","year":"2023","journal-title":"J Eur Orthop Surg Traumatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"145","DOI":"10.4103\/joco.joco_176_23","article-title":"Meibomian gland loss and dysfunction in mild versus moderate-severe thyroid eye disease","volume":"36","author":"Aghaei","year":"2024","journal-title":"J Curr Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.jcjo.2017.11.006","article-title":"Functional and structural evaluation of the meibomian gland using a LipiView interferometer in thyroid eye disease","volume":"53","author":"Park","year":"2018","journal-title":"Can J Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4574","DOI":"10.1167\/iovs.10-5380","article-title":"Corneal involvement in Graves' orbitopathy: an in vivo confocal study","volume":"51","author":"Villani","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA."},{"key":"B20","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1472-6947-7-16","article-title":"Utilization of the PICO framework to improve searching PubMed for clinical questions","volume":"7","author":"Schardt","year":"2007","journal-title":"BMC Med Inform Decis Mak"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e220189","DOI":"10.1530\/ETJ-22-0189","article-title":"Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association","volume":"11","author":"Burch","year":"2022","journal-title":"Eur Thyroid J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"G43","DOI":"10.1530\/EJE-21-0861","article-title":"The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy","volume":"185","author":"Bartalena","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/j.ophtha.2007.06.031","article-title":"Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population","volume":"115","author":"Arita","year":"2008","journal-title":"Ophthalmology."},{"key":"B24","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/1471-2288-14-45","article-title":"Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments","volume":"14","author":"Lo","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.7326\/0003-4819-142-12_Part_2-200506211-00002","article-title":"Better information for better health care: the evidence-based practice center program and the agency for healthcare research and quality","volume":"142","author":"Atkins","year":"2005","journal-title":"Ann Intern Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1177\/09622802221139233","article-title":"Standard error estimation in meta-analysis of studies reporting medians","volume":"32","author":"McGrath","year":"2023","journal-title":"Stat Methods Med Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"LUO","year":"2018","journal-title":"Stat Methods Med Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"ED000163","DOI":"10.1002\/14651858.ED000163","article-title":"Evaluating medical tests: introducing the cochrane handbook for systematic reviews of diagnostic test accuracy","volume":"7","author":"Bossuyt","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1007\/s10792-024-02919-y","article-title":"Ocular surface and meibomian gland evaluation in euthyroid Graves' ophthalmopathy","volume":"44","author":"Lai","year":"2024","journal-title":"Int Ophthalmol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"3066","DOI":"10.3390\/jcm12093066","article-title":"Ocular surface changes in treatment-naive thyroid eye disease","volume":"12","author":"Liao","year":"2023","journal-title":"J Clin Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-021-02024-z","article-title":"In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves' orbitopathy","author":"Cheng","year":"2021","journal-title":"BMC Ophthalmol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12886-018-0763-9","article-title":"The function and morphology of Meibomian glands in patients with thyroid eye disease: a preliminary study","volume":"18","author":"Wang","year":"2018","journal-title":"BMC Ophthalmol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1177\/11206721251332675","article-title":"Investigation of corneal structural changes by in vivo confocal microscopy in thyroid-associated ophthalmopathy patients","volume":"35","author":"Guleser","year":"2025","journal-title":"Eur J. Ophthalmol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1097\/IOP.0000000000002280","article-title":"Is Corneal subbasal nerve loss associated with meibomian gland loss in inactive mild and moderate-to-severe graves' ophthalmopathy?","volume":"39","author":"Yilmaz Tugan","year":"2023","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1080\/08820538.2021.1937662","article-title":"Evaluation of meibomian gland loss and ocular surface changes in patients with mild and moderate-to-severe graves' ophthalmopathy","volume":"37","author":"Yilmaz Tugan","year":"2022","journal-title":"Semi Ophthalmol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e800","DOI":"10.1111\/aos.14000","article-title":"Dry eye syndrome in thyroid eye disease patients: the role of increased incomplete blinking and Meibomian gland loss","volume":"97","author":"Park","year":"2019","journal-title":"Acta Ophthalmologica."},{"key":"B39","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.jcjo.2015.05.012","article-title":"Meibomian gland dysfunction in Graves' orbitopathy","volume":"50","author":"Kim","year":"2015","journal-title":"Can J Ophthalmol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"3465","DOI":"10.2147\/OPTH.S430861","article-title":"Ocular Surface disease related to the inflammatory and non-inflammatory phases of thyroid eye disease","volume":"17","author":"Riguetto","year":"2023","journal-title":"Clin. Ophthalmol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2481","DOI":"10.2147\/OPTH.S317708","article-title":"Ocular surface changes in patients with thyroid eye disease: an observational clinical study","volume":"15","author":"Allam","year":"2021","journal-title":"Clin Ophthalmol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"e0250617","DOI":"10.1371\/journal.pone.0250617","article-title":"Meibomian glands dropout in patients with inactive thyroid related orbitopathy","volume":"16","author":"Satitpitakul","year":"2021","journal-title":"PloS One"},{"key":"B43","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1097\/ICO.0000000000002404","article-title":"In vivo confocal microscopy morphometric analysis of meibomian glands in patients with graves ophthalmopathy","volume":"40","author":"Vagge","year":"2021","journal-title":"Cornea."},{"key":"B44","doi-asserted-by":"publisher","first-page":"2814","DOI":"10.3390\/jcm9092814","article-title":"Investigation of meibomian gland function and dry eye disease in patients with graves' ophthalmopathy","volume":"9","author":"Inoue","year":"2020","journal-title":"J Clin Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"102369","DOI":"10.1016\/j.clae.2025.102369","article-title":"Blink completeness and rate in dry eye disease: an investigator-masked, prospective registry-based, cross-sectional, prognostic study","volume":"48","author":"Wang","year":"2025","journal-title":"Cont Lens Anterior Eye."},{"key":"B46","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.exer.2017.02.008","article-title":"Meibocyte differentiation and renewal: Insights into novel mechanisms of meibomian gland dysfunction (MGD)","volume":"163","author":"Hwang","year":"2017","journal-title":"Exp Eye Res"},{"key":"B47","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jtos.2023.11.005","article-title":"Modeling meibum secretion: alternatives for obstructive Meibomian Gland Dysfunction (MGD)","volume":"31","author":"Luo","year":"2024","journal-title":"Ocular Surface."},{"key":"B48","doi-asserted-by":"publisher","first-page":"48","DOI":"10.47391\/JPMA.11233","article-title":"Tear film parameters in females with thyroid eye disease and diabetes: an observational study","volume":"75","author":"Alanazi","year":"2025","journal-title":"J Pak Med Assoc."},{"key":"B49","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1097\/ACI.0b013e32830e6b04","article-title":"Functions of ocular surface mucins in health and disease","volume":"8","author":"Mantelli","year":"2008","journal-title":"Curr Opin Allergy Clin Immunol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1167\/iovs.10-6997c","article-title":"The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland","volume":"52","author":"Knop","year":"2011","journal-title":"Invest Ophthalmol Visual Sci"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/ICL.0000000000000336","article-title":"The relationship between morphology and function of the meibomian glands","volume":"44","author":"Kim","year":"2018","journal-title":"Eye Contact Lens."},{"key":"B52","doi-asserted-by":"publisher","first-page":"982","DOI":"10.3109\/02713683.2014.971929","article-title":"Evaluation of meibomian gland dysfunction and local distribution of meibomian gland atrophy by non-contact infrared meibography","volume":"40","author":"Finis","year":"2015","journal-title":"Curr Eye Res."},{"key":"B53","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1097\/00003226-199407000-00012","article-title":"Tear film lipid layer thickness as a function of blinking","volume":"13","author":"Korb","year":"1994","journal-title":"Cornea."},{"key":"B54","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1167\/iovs.65.8.49","article-title":"Meibomian gland shortening is associated with altered meibum composition","volume":"65","author":"Iqbal","year":"2024","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B55","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3126\/nepjoph.v15i1.46909","article-title":"Association of meibomian gland dysfunction with serum lipid profile: a hospital-based cross-sectional study","volume":"15","author":"Shakya","year":"2023","journal-title":"Nepal J Ophthalmol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"927","DOI":"10.3109\/02713683.2015.1133833","article-title":"Observation of corneal langerhans cells by in vivo confocal microscopy in thyroid-associated ophthalmopathy","volume":"41","author":"Wu","year":"2016","journal-title":"Curr Eye Res"},{"key":"B57","doi-asserted-by":"publisher","first-page":"6111","DOI":"10.1167\/iovs.18-25571","article-title":"Clinically relevant immune-cellular metrics of inflammation in meibomian gland dysfunction","volume":"59","author":"Qazi","year":"2018","journal-title":"Invest Ophthalmol Visual Sci"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1080\/02713683.2025.2521865","article-title":"Quantification of conjunctival dendritiform cells under in vivo confocal microscopy for clinical activity evaluation in thyroid eye disease","volume":"50","author":"Cai","year":"2025","journal-title":"Curr Eye Res."},{"key":"B59","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1161\/01.STR.32.3.649","article-title":"Androgen regulation of gene expression in human meibomian gland and conjunctival epithelial cells","volume":"18","author":"Khandelwal","year":"2012","journal-title":"Mol Vis."},{"key":"B60","doi-asserted-by":"publisher","first-page":"28118","DOI":"10.1038\/s41598-024-73969-6","article-title":"Activation of the mTOR pathway enhances PPAR\u03b3\/SREBP-mediated lipid synthesis in human meibomian gland epithelial cells","volume":"14","author":"Jun","year":"2024","journal-title":"Sci. Rep."},{"key":"B61","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.jtos.2019.05.007","article-title":"Evaluation of incomplete blinking as a measurement of dry eye disease","volume":"17","author":"Jie","year":"2019","journal-title":"Ocul Surf"},{"key":"B62","doi-asserted-by":"publisher","first-page":"7648","DOI":"10.1038\/s41598-019-44000-0","article-title":"Meibum expressibility improvement as a therapeutic target of intense pulsed light treatment in meibomian gland dysfunction and its association with tear inflammatory cytokines","volume":"9","author":"Choi","year":"2019","journal-title":"Sci. Rep"},{"key":"B63","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.1007\/s40123-024-00976-1","article-title":"Vectored thermal pulsation as a treatment for meibomian gland dysfunction: a review spanning 15 years","volume":"13","author":"Blackie","year":"2024","journal-title":"Ophthalmol Ther."},{"key":"B64","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3109\/09273948.2014.986581","article-title":"Age-related defects in ocular and nasal mucosal immune system and the immunopathol dry eye disease","volume":"24","author":"Farid","year":"2016","journal-title":"Ocular Immunol. Inflame."},{"key":"B65","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1097\/IOP.0b013e3182611641","article-title":"In vivo examination of meibomian gland morphology in patients with facial nerve palsy using infrared meibography","volume":"28","author":"Call","year":"2012","journal-title":"Ophth Plastic Reconstruct Surg."},{"key":"B66","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1097\/ICO.0000000000000815","article-title":"Epidemiology of meibomian gland dysfunction in an elderly population","volume":"35","author":"Alghamdi","year":"2016","journal-title":"Cornea"},{"key":"B67","doi-asserted-by":"publisher","first-page":"383","DOI":"10.4103\/ijo.IJO_915_17","article-title":"Ultrasound biomicroscopy image patterns in normal upper eyelid and congenital ptosis in the Indian population","volume":"66","author":"Surve","year":"2018","journal-title":"Ind J Ophthalmol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1709057\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T06:32:30Z","timestamp":1762842750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1709057\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":67,"alternative-id":["10.3389\/fmed.2025.1709057"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1709057","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]},"article-number":"1709057"}}