Comparison of Meibomian Gland Loss Between Pediatric Patients with Blepharo-Keratoconjunctivitis and Age-Matched Controls Using Non-Contact Meibography.

Objectives: To compare the extent of meibomian gland loss in pediatric patients with blepharo-keratoconjunctivitis (BKC), allergic conjunctivitis, and healthy controls using non-contact infrared meibography. Methods: This retrospective observational study included 81 patients aged 18 years or younger: 20 with BKC, 29 with allergic conjunctivitis, and 32 healthy controls. Meibomian gland loss in the upper and lower eyelids was quantified on non-contact infrared meibography images. Right and left eyes were analyzed separately, and only eyes with the same laterality were compared among groups. Results: Meibomian gland loss was significantly greater in the BKC group than in the allergic conjunctivitis and control groups in all four eyelids (right, left, upper and lower; all p < 0.001). In contrast, gland loss in allergic conjunctivitis showed intermediate values between BKC and controls and did not differ significantly from controls in some eyelids. Within the BKC group, meibomian gland loss did not differ significantly between eyes with and without overt corneal or conjunctival lesions (p ≥ 0.05). Conclusions: Pediatric patients with BKC demonstrate marked meibomian gland loss compared with allergic conjunctivitis and healthy eyes. These findings suggest that BKC represents a particularly aggressive form of MGD. Importantly, early recognition and appropriate treatment of BKC in pediatric patients may help prevent recurrent inflammation and halt further meibomian gland loss, thereby reducing long-term MGD.