A recent pilot study explored the use of meibomian gland dropout in the upper eyelids as a noninvasive biomarker for early diagnosis of primary Sjögren’s syndrome.

The study examined 56 patients with suspected primary Sjögren’s syndrome (pSS) using infrared imaging and histopathological evaluation. The researchers identified pSS in 34 patients, while 22 patients were diagnosed with non-SS dry eye and served as the control group. “The onset of pSS remains frequently insidious, presenting with an accumulation of different subtle changes in the exocrine glands for an average of 7 years prior to receiving a diagnosis,” the researchers wrote in their article, published in Therapeutic Advances in Musculoskeletal Disease. Among the signs and symptoms, patients often experience dry mouth and keratoconjunctivitis sicca.

While testing criteria for pSS currently exists, the salivary gland biopsy procedure used in this testing can be invasive and shortcomings include pain, anxiety, hematoma, bleeding, and granuloma. Given the increasing evidence that progressive meibomian gland function is more common in pSS than non-SS dry eye, the investigators aimed to determine whether noninvasive procedures to detect meibomian gland dropout in clinical practice could be correlated with criteria for pSS.

The study showed that gland dropout correlated with lymphocytic infiltration in the meibomian glands of pSS patients, indicating a potential link between gland damage and autoimmune activity. The study also found significantly higher meibomian gland dropout rates in the upper eyelids of pSS patients compared to controls with non-SS dry eye.

“Notably, we found that meibomian gland dropout was significantly severe in the temporal rather than in the nasal region of the upper eyelids in patients with pSS,” the investigators explained. “This observation of temporal dropout of meibomian glands reveals an early stage event in the progress of pSS; morphological analysis of the temporal region in the upper meibomian glands may thus be a more sensitive indicator of dysfunction in the early stage of pSS.” Further, temporal meibomian gland dropout in the upper eyelids showed high predictive accuracy for pSS classification.

As a sensitive and noninvasive predictive biomarker, the researchers concluded that meibomian gland dropout rate may be an alternative to the current “gold standard” parameters obtained by biopsies in detecting pSS.

A full list of author disclosures can be found in the published research.