The role of lid margin structures in the meibomian gland function and ocular surface health

Introduction: The lid margins are essential to maintain a healthy tear film and distribute it over the ocular surface to achieve an optimal refractive interface. Alterations in the lid margin structures and function may lead to significant ocular surface problems. Meibomian gland dysfunction is usually attributed to be the most common reason for ocular surface disease. However, the lid margin disease cannot be fully understood and adequately addressed if the function of the meibomian glands is not evaluated in relation to other lid margin structures. Areas covered: This review aims to emphasize that the lid margin requires a full assessment in order to address ocular surface diseases associated with lid margin disease. The different zones of the lid margin and their roles in the maintenance of ocular surface health are delineated. Alterations in the lid margin structures due to increasing age or underlying etiology and their potential impact are discussed. Expert commentary: If structural abnormalities are not recognized and properly addressed, the treatment of meibomian gland dysfunction will likely fail. Future studies focusing on the underlying etiology of structural alterations will hopefully lead to the development of more effective therapeutic options.