{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:25:24Z","timestamp":1777861524050,"version":"3.51.4"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"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>Although postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) frequently present with concurrent meibomian gland dysfunction (MGD), and PANDO is known to contribute to ocular surface inflammation, the specific factors driving MGD in these patients remain unclear. This study aimed to identify and assess key demographic, clinical, and hormonal factors associated with MGD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective study included 272 postmenopausal women (180 with PANDO, 92 controls). All underwent standardized assessments: meibography (Keratograph 5 M) for gland loss, slit-lamp MG evaluation, and the Ocular Surface Disease Index (OSDI) questionnaire. Multivariable regression identified independent MGD risk factors, adjusting for age, menopause duration, obstruction completeness, disease duration, and dacryocystitis. Exploratory tear cytokine (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f71) and serum hormone (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f98) analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjustment, incomplete obstruction showed the strongest independent association with severe upper eyelid MG loss (95% CI: 2.48\u20138.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and a 2.02-fold increased odds of worse lower eyelid meibum quality (95% CI: 1.13\u20133.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.019). A longer duration of PANDO was associated with reduced odds of expressibility impairment (OR\u202f=\u202f0.96 per year,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.027). Higher non-invasive tear meniscus height predicted longer tear breakup time (\n                      <jats:italic>B<\/jats:italic>\n                      \u202f=\u202f2.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Several univariately significant factors lost independence in multivariable models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Incomplete PANDO is the principal factor associated with severe, often asymptomatic MGD in postmenopausal women in this cross-sectional analysis. Clinical evaluation should extend beyond epiphora. Routine meibography is recommended to detect silent gland atrophy and guide ocular surface preservation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1831157","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:21:57Z","timestamp":1777522917000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incomplete rather than complete nasolacrimal duct obstruction Is strongly associated with meibomian gland dysfunction in postmenopausal women with PANDO: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Haili","family":"Jin","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Wuhu Eye Hospital","place":["Wuhu, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Wuhu Eye Hospital","place":["Wuhu, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianjie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Wuhu Eye Hospital","place":["Wuhu, Anhui, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1167\/iovs.64.10.13","article-title":"Obstruction of the tear drainage altered lacrimal gland structure and function","volume":"64","author":"Xiao","year":"2023","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1136\/bjophthalmol-2021-319677","article-title":"Metagenomics of the lacrimal sac in primary acquired nasolacrimal duct obstruction: the Lacriome paper 1","volume":"107","author":"Ali","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1080\/02713683.2019.1665186","article-title":"Alteration of tear cytokine expressions in primary acquired nasolacrimal duct obstruction - potential insights into the etiopathogenesis","volume":"45","author":"Ali","year":"2020","journal-title":"Curr Eye Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1080\/08820538.2021.1889619","article-title":"Matrix metalloproteinase-9 point-of-care immunoassay after dacryocystorhinostomy in patients with nasolacrimal duct obstruction","volume":"36","author":"Woo","year":"2021","journal-title":"Semin Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e395","DOI":"10.1097\/SCS.0000000000009325","article-title":"Meibomian gland dysfunction in primary acquired nasolacrimal duct obstruction","volume":"34","author":"Yoon","year":"2023","journal-title":"J Craniofac Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12886-023-02799-3","article-title":"Changes in the meibomian glands in postmenopausal women with primary acquired nasolacrimal duct obstruction: a prospective study","volume":"23","author":"Jin","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1007\/s10792-024-03204-8","article-title":"Dry eye and decreased tear film stability in primary acquired nasolacrimal duct obstruction patients","volume":"44","author":"Yu","year":"2024","journal-title":"Int Ophthalmol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0247168","DOI":"10.1371\/journal.pone.0247168","article-title":"Modified ocular surface disease index as a screening criteria for dry eye syndrome presenting after successful dacryocystorhinostomy","volume":"16","author":"Kang","year":"2021","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2662","DOI":"10.1177\/11206721211069739","article-title":"Prevalence and risk factors of dry eye symptoms after successful dacryocystorhinostomy for patients with lacrimal passage obstruction","volume":"32","author":"Jin","year":"2022","journal-title":"Eur J Ophthalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"101193","DOI":"10.1016\/j.preteyeres.2023.101193","article-title":"Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO)","volume":"96","author":"Ali","year":"2023","journal-title":"Prog Retin Eye Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1007\/s00417-023-06352-2","article-title":"Are inflammation-related diseases risk factors for primary acquired nasolacrimal duct obstruction? A large scale, national case-control study","volume":"262","author":"Kerber","year":"2024","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II epidemiology report","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul Surf"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1080\/07853890.2022.2056238","article-title":"Lipid layer thickness decrease due to meibomian gland dysfunction leads to tear film instability and reflex tear secretion","volume":"54","author":"Kim","year":"2022","journal-title":"Ann Med"},{"key":"ref14","first-page":"1055","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":"ref15","doi-asserted-by":"publisher","first-page":"7229","DOI":"10.21037\/qims-24-519","article-title":"Predictors of nasolacrimal duct intubation failure for primary acquired nasolacrimal duct obstruction: a computed tomography-dacryocystography (CT-DCG) study","volume":"14","author":"Wang","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"5129","DOI":"10.3390\/jcm13175129","article-title":"Dacryocystitis: is dacryocystorhinostomy always the solution?","volume":"13","author":"Mathieu","year":"2024","journal-title":"J Clin Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1097\/ICO.0000000000003768","article-title":"Investigating risk factors for meibomian gland dysfunction and loss among Young medical trainees","volume":"44","author":"Farid","year":"2024","journal-title":"Cornea"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ajo.2016.06.025","article-title":"Development of definitive and reliable grading scales for meibomian gland dysfunction","volume":"169","author":"Arita","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1136\/bjophthalmol-2021-318876","article-title":"Morphological variants of meibomian glands: correlation of meibography features with histopathology findings","volume":"107","author":"Singh","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e090305","DOI":"10.1136\/bmjopen-2024-090305","article-title":"Comparison of non-invasive and fluorescein tear film break-up time in a 65-year-old Norwegian population: a cross-sectional study","volume":"15","author":"Tashbayev","year":"2025","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0305020","DOI":"10.1371\/journal.pone.0305020","article-title":"Tolerability of Diquas LX on tear film and meibomian glands findings in a real clinical scenario","volume":"19","author":"Arita","year":"2024","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1080\/02713683.2024.2324432","article-title":"Analysis of factors associated with anterior location of Marx's line","volume":"49","author":"Sun","year":"2024","journal-title":"Curr Eye Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jtos.2020.11.007","article-title":"Relationship between eyelid margin irregularity and meibomian gland loss","volume":"19","author":"Ha","year":"2021","journal-title":"Ocul Surf"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e507","DOI":"10.1002\/mco2.507","article-title":"Efficacy of far infrared functional glasses in the treatment of meibomian gland dysfunction-related dry eye","volume":"5","author":"Tian","year":"2024","journal-title":"MedComm"},{"key":"ref25","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":"ref26","doi-asserted-by":"publisher","first-page":"e0296296","DOI":"10.1371\/journal.pone.0296296","article-title":"Composition and diversity of meibum microbiota in meibomian gland dysfunction and the correlation with tear cytokine levels","volume":"18","author":"Rasaruck","year":"2023","journal-title":"PLoS One"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s10792-024-03041-9","article-title":"Higher incidence of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction","volume":"44","author":"Guoping","year":"2024","journal-title":"Int Ophthalmol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1186\/s12886-025-04439-4","article-title":"Upper eyelid predominance of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction","volume":"25","author":"Haili","year":"2025","journal-title":"BMC Ophthalmol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"915","DOI":"10.18240\/ijo.2021.06.18","article-title":"Androgen and meibomian gland dysfunction: from basic molecular biology to clinical applications","volume":"14","author":"Wang","year":"2021","journal-title":"Int J Ophthalmol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1167\/iovs.07-1458","article-title":"Estrogen and progesterone control of gene expression in the mouse meibomian gland","volume":"49","author":"Suzuki","year":"2008","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.jtos.2017.04.001","article-title":"TFOS DEWS II sex, gender, and hormones report","volume":"15","author":"Sullivan","year":"2017","journal-title":"Ocul Surf"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul Surf"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1097\/OPX.0b013e3180dc9a23","article-title":"Tear osmolality and ferning patterns in postmenopausal women","volume":"84","author":"Srinivasan","year":"2007","journal-title":"Optom Vis Sci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1136\/bjo-2022-322238","article-title":"Sex-related differences and hormonal effects in the dry eye assessment and management (DREAM) study","volume":"108","author":"Zhao","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1080\/02713683.2016.1196706","article-title":"Tear-film osmolarity changes following dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction","volume":"42","author":"Yuksel","year":"2017","journal-title":"Curr Eye Res"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/j.ajo.2005.12.051","article-title":"Prospective controlled study of vapor pressure tear osmolality and tear meniscus height in nasolacrimal duct obstruction","volume":"141","author":"Stahl","year":"2006","journal-title":"Am J Ophthalmol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1097\/IOP.0b013e31825e6960","article-title":"Tear film osmolarity in epiphora","volume":"28","author":"Saleh","year":"2012","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e0266040","DOI":"10.1371\/journal.pone.0266040","article-title":"Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction","volume":"17","author":"Yang","year":"2022","journal-title":"PLoS One"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.1007\/s00417-019-04392-1","article-title":"Effect of topical steroids on recently developed incomplete nasolacrimal duct obstruction: optical coherence tomography study","volume":"257","author":"Yang","year":"2019","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.exer.2003.09.003","article-title":"The role of the lacrimal functional unit in the pathophysiology of dry eye","volume":"78","author":"Stern","year":"2004","journal-title":"Exp Eye Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.preteyeres.2009.04.003","article-title":"Neural regulation of lacrimal gland secretory processes: relevance in dry eye diseases","volume":"28","author":"Dartt","year":"2009","journal-title":"Prog Retin Eye Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.jtos.2017.05.002","article-title":"TFOS DEWS II pain and sensation report","volume":"15","author":"Belmonte","year":"2017","journal-title":"Ocul Surf"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"4248","DOI":"10.3390\/jcm10184248","article-title":"The role of neuropeptides in pathogenesis of dry dye","volume":"10","author":"Hwang","year":"2021","journal-title":"J Clin Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.stemcr.2016.07.010","article-title":"Renewal of the holocrine meibomian glands by label-retaining, unipotent epithelial progenitors","volume":"7","author":"Parfitt","year":"2016","journal-title":"Stem Cell Reports"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.1016\/j.ophtha.2009.04.037","article-title":"Proposed diagnostic criteria for obstructive meibomian gland dysfunction","volume":"116","author":"Arita","year":"2009","journal-title":"Ophthalmology"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1177\/1535370220928275","article-title":"Histopathological changes in tear-secreting tissues and cornea in a mouse model of autoimmune disease","volume":"245","author":"Hiraishi","year":"2020","journal-title":"Exp Biol Med (Maywood)"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1080\/01676830.2022.2119261","article-title":"Tear instability in the fellow eye of unilateral nasolacrimal obstruction and resolution with dacryocystorhinostomy","volume":"42","author":"T\u0131skao\u011flu","year":"2023","journal-title":"Orbit"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831157\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:22:13Z","timestamp":1777522933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831157\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":47,"alternative-id":["10.3389\/fmed.2026.1831157"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1831157","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"article-number":"1831157"}}