{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:16:17Z","timestamp":1791598577592,"version":"4.3.4"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To compare the function and morphology of the meibomian glands and the ocular surface of individuals from highland and lowland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a randomized controlled trial. The study was performed with 104 individuals (51 individuals from the highland and 53 individuals from the lowland). Detailed eye examinations comprising tear meniscus height, lipid layer grading, non-invasive Keratograph tear breakup time (NIKBUT), and scoring of the meibomian glands from the upper and lower eyelids of the individuals were performed by Keratograph 5M (OCULUS, Wetzlar, Germany). Symptoms related to dry eye disease were assessed using the Ocular Surface Disease Index (OSDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In the highland group, tear meniscus height was lower (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.024), lipid layer grade, as well as all the meiboscores were higher (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05) than that in the lowland group. The OSDI (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.018) and the percentage of dry eye disease were also higher as compared to that of the lowland group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.032). The first NIKBUT and average NIKBUT did not differ significantly between groups. The frequency of plugged meibomian gland orifices was greater in the lowland group compared to the highland group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.036).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>It was observed that dry eye disease was more common in the highland group. The morphological changes of meibomian gland dropout were significant in highlanders as demonstrated objectively with Keratograph 5M. Our study may raise a concern for environmental influences on ocular surface changes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2657_22","type":"journal-article","created":{"date-parts":[[2023,4,8]],"date-time":"2023-04-08T11:10:52Z","timestamp":1680952252000},"page":"1483-1487","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Functional and morphological evaluation of the meibomian glands and ocular surface assessment at high altitude"],"prefix":"10.4103","volume":"71","author":[{"given":"Zhouyu","family":"Li","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"Wan","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ji","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijie","family":"Zheng","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Hu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4,5]]},"reference":[{"key":"R1-20240828","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/aos.13897","article-title":"Retinal vessel oxygen saturation and vessel diameter in healthy individuals during high-altitude exposure","volume":"97","author":"Yang","year":"2019","journal-title":"Acta Ophthalmol"},{"key":"R2-20240828","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1136\/jramc-157-01-09","article-title":"The effect of high altitude on the visual system","volume":"157","author":"Gibson","year":"2011","journal-title":"J R Army Med Corps"},{"key":"R3-20240828","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/S0161-6420(96)30523-X","article-title":"Refractive changes during 72-hour exposure to high altitude after refractive surgery","volume":"103","author":"Mader","year":"1996","journal-title":"Ophthalmology"},{"key":"R4-20240828","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1080\/09286586.2020.1849741","article-title":"Biogeographical and altitudinal distribution of cataract: A nine-year experience using electronic medical record-driven big data analytics in India","volume":"28","author":"Garrigan","year":"2021","journal-title":"Ophthalmic Epidemiol"},{"key":"R5-20240828","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1089\/ham.2007.1055","article-title":"Prevalence of dry eye at high altitude: A case controlled comparative study","volume":"9","author":"Gupta","year":"2008","journal-title":"High Alt Med Biol"},{"key":"R6-20240828","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/5935239","article-title":"Tear film instability and meibomian gland dysfunction correlate with the pterygium size and thickness pre- and postexcision in patients with pterygium","volume":"2019","author":"Li","year":"2019","journal-title":"J Ophthalmol"},{"key":"R7-20240828","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II definition and classification report","volume":"15","author":"Craig","year":"2017","journal-title":"Ocul Surf"},{"key":"R8-20240828","doi-asserted-by":"crossref","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":"R9-20240828","doi-asserted-by":"crossref","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":"R10-20240828","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jtos.2016.09.003","article-title":"New perspectives on dry eye definition and diagnosis: A consensus report by the asia dry eye society","volume":"15","author":"Tsubota","year":"2017","journal-title":"Ocul Surf"},{"key":"R11-20240828","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1016\/j.ophtha.2015.02.013","article-title":"Seasonal variation in dry eye","volume":"122","author":"Kumar","year":"2015","journal-title":"Ophthalmology"},{"key":"R12-20240828","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1001\/jamaophthalmol.2016.0139","article-title":"Potential importance of ozone in the association between outdoor air pollution and dry eye disease in South Korea","volume":"134","author":"Hwang","year":"2016","journal-title":"JAMA Ophthalmol"},{"key":"R13-20240828","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1097\/ICO.0000000000002045","article-title":"Short-term effects of ground-level ozone in patients with dry eye disease: A prospective clinical study","volume":"38","author":"Kim","year":"2019","journal-title":"Cornea"},{"key":"R14-20240828","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/ICL.0b013e318193f4fc","article-title":"Factors affecting evaporation rates of tear film components measured in vitro","volume":"35","author":"Borchman","year":"2009","journal-title":"Eye Contact Lens"},{"key":"R15-20240828","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jtos.2018.03.001","article-title":"Effects of environment pollution on the ocular surface","volume":"16","author":"Jung","year":"2018","journal-title":"Ocul Surf"},{"key":"R16-20240828","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.freeradbiomed.2013.05.006","article-title":"Effects of ozone exposure on the ocular surface","volume":"63","author":"Lee","year":"2013","journal-title":"Free Radic Biol Med"},{"key":"R17-20240828","first-page":"1","article-title":"Short-Term effects of ambient ozone on the risk of conjunctivitis outpatient visits: A time-series analysis in Pudong New Area, Shanghai","volume":"2022","author":"Cheng","journal-title":"Int J Environ Health Res"},{"key":"R18-20240828","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.jtos.2017.03.006","article-title":"TFOS DEWS II tear film report","volume":"15","author":"Willcox","year":"2017","journal-title":"Ocul Surf"},{"key":"R19-20240828","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1006\/exer.2001.1045","article-title":"Epithelial mucins of the ocular surface: Structure, biosynthesis and function","volume":"73","author":"Arg\u00fceso","year":"2001","journal-title":"Exp Eye Res"},{"key":"R20-20240828","doi-asserted-by":"crossref","first-page":"8340","DOI":"10.1167\/iovs.15-17468","article-title":"Effect of stratification on surface properties of corneal epithelial cells","volume":"56","author":"Y\u00e1\u00f1ez-Soto","year":"2015","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R21-20240828","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/ICO.0b013e318165b1b7","article-title":"Dry eye syndrome in elderly Tibetans at high altitude: A population-based study in China","volume":"27","author":"Lu","year":"2008","journal-title":"Cornea"},{"key":"R22-20240828","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/ceo.12810","article-title":"Ocular surface microbiome in meibomian gland dysfunction","volume":"45","author":"Watters","year":"2017","journal-title":"Clin Exp Ophthalmol"},{"key":"R23-20240828","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ophtha.2017.05.031","article-title":"Meibomian gland disease: The role of gland dysfunction in dry eye disease","volume":"124","author":"Chhadva","year":"2017","journal-title":"Ophthalmology"},{"key":"R24-20240828","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/152702903322616173","article-title":"Going to high altitude with preexisting ocular conditions","volume":"4","author":"Mader","year":"2003","journal-title":"High Alt Med Biol"},{"key":"R25-20240828","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jtos.2013.08.002","article-title":"Effect of desiccating stress on mouse meibomian gland function","volume":"12","author":"Suhalim","year":"2014","journal-title":"Ocul Surf"},{"key":"R26-20240828","doi-asserted-by":"crossref","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":"R27-20240828","doi-asserted-by":"crossref","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 Vis Sci"},{"key":"R28-20240828","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jtos.2018.12.001","article-title":"Hypoxia: A breath of fresh air for the meibomian gland","volume":"17","author":"Liu","year":"2019","journal-title":"Ocul Surf"},{"key":"R29-20240828","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jtos.2017.05.001","article-title":"TFOS DEWS II diagnostic methodology report","volume":"15","author":"Wolffsohn","year":"2017","journal-title":"Ocul Surf"},{"key":"R30-20240828","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.exer.2015.05.002","article-title":"The real reason for having a meibomian lipid layer covering the outer surface of the tear film-A review","volume":"137","author":"Millar","year":"2015","journal-title":"Exp Eye Res"},{"key":"R31-20240828","doi-asserted-by":"crossref","first-page":"105253","DOI":"10.1016\/j.micpath.2021.105253","article-title":"Ocular microbial diversity, community structure, and function at high altitude","volume":"161","author":"Li","year":"2021","journal-title":"Microb Pathog"},{"key":"R32-20240828","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S1542-0124(12)70138-6","article-title":"Meibomian gland function and the tear lipid layer","volume":"1","author":"McCulley","year":"2003","journal-title":"Ocul Surf"},{"key":"R33-20240828","doi-asserted-by":"crossref","first-page":"5616","DOI":"10.1167\/iovs.07-0588","article-title":"Ocular pathogen or commensal: A PCR-based study of surface bacterial flora in normal and dry eyes","volume":"48","author":"Graham","year":"2007","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R34-20240828","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/ICL.0000000000000673","article-title":"Effect of eyelid treatments on bacterial load and lipase activity in relation to contact lens discomfort","volume":"46","author":"Siddireddy","year":"2020","journal-title":"Eye Contact Lens"},{"key":"R35-20240828","first-page":"486","article-title":"Bacterial lipases and chronic blepharitis","volume":"27","author":"Dougherty","year":"1986","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2657_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:29:43Z","timestamp":1786724983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2657_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_2657_22","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"assertion":[{"value":"2022-10-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}