Meibomian Marginal Dimples

Abstract

Lipids in meibomian secretion have been incriminated as inducers of some eyelid disorders. Consideration of eyelid dimples provides additional clinical evidence for this hypothesis. We need to draw attention to focal dimples and related indentations in eyelid margins; to demonstrate their intra-tarsal and marginal associations, as well as their relationship to meibomian duct-gland complexes (DGC); and to identify possible inducer agents and mechanisms. Patients with lesions of this type were sought and recruited from private and hospital clinics. The subject lesions were photographed revealing no signs of infection or neoplasia. Affected lid margins were inert and free of surface inflammation. On the other hand, a disordered DGC was found beneath each indentation, which in turn coincided with the relevant meibomian orifice. It was demonstrable that the dimpling process extended, in some cases, to notches, serrations and grooves. Associated intra-tarsal disorders found, were comedonic accumulation of meibum, linear granuloma, calcification and atrophic “drop-out” of DGC. Among marginal associations of dimpling were adjacent focal trichiasis and zones of lash deviation. Aberrant meibomian lashes were also encountered with dimples and, in individual cases, some combinations of these findings also occurred. From these appearances it was concluded that the indentations arose from post-inflammatory contracture along the DGC axis, aggravated in some by loss of submarginal bulk (“drop-out”). Strangulation by fibrosis may contribute to “drop-out.” In aggregate, the findings support the view that there exist autotoxic pro-inflammatory and pro-metaplastic inducers derivable from meibum irrespective of bacterial liberation of free fatty acids. The constraint of comedo and granuloma to spindle shape suggests that patho-genesis can occur without breaching the walls of the DGC.