Clinical measurements and subject inclusion

Meibomian glands (MG) in one eye (overall 76 UL and 49 LL) of 125 patients, randomly selected from a patient pool presenting with subjective dry eye symptoms at a private practice in Kumasi Ghana, were photographed with the custom-made meibographer. Single frames were captured, and the MG area was determined. Additionally, a thorough slit lamp examination was conducted, and 2% topical fluorescein was applied to the ocular surface to measure Tear Film Break – Up Time (TBUT). We also graded Ocular Surface Staining (OSS) in 95 subjects using the Oxford Grading Scheme described by Bron et al. [27] using a Wratten # 12 filter (Kodak, New Jersey, USA). Symptoms of DED were evaluated using the SPEED II Questionnaire.

None of subjects included in the study had a history of ocular surgery including lid correction, neither did any report use of systemic drugs like isotretinoin [28] that could impair MG function. Further, none of the subjects had ever received treatment for MGD prior to the study.