Introduction

The association between lid margin collarettes and meibomian gland dysfunction (MGD) and dry eye symptoms has not been explored completely till date.

Aim

To ascertain the impact of collarettes on dry eye disease (DED).

Patient Profile

• Patients with moderate-to- severe dry eye disease who had participated in the “Dry Eye Assessment and Management” (DREAM) study.
• The participants showed both signs (e.g. conjunctival staining, corneal fluoresceine staining, tear film break-up time) and symptoms, including the Ocular Surface Disease Index (OSDI), with dry eye-related symptoms lasting ≥ 6 months.

Methods

Study Design

• A secondary analysis of the DREAM study.
• The DREAM study was a multicentre (conducted across 27 clinical sites), double-blinded clinical trial that evaluated the efficacy and safety of omega-3 fatty acid supplementation for treating DED.

Assessments

• Lid margin debris were evaluated on both upper and lower eyelids of each eye and were graded as: normal (0 collarettes), mild (1–5 collarettes), moderate (6–20 collarettes, a few fragments), severe (21–40 collarettes, 1–2 clumps), and very severe (40∫∠collarettes; more than 3 clumps).
• The measures for DED signs evaluated in each eye included: eyelid erythema, conjunctival lissamine green staining, corneal fluorescein staining, TBUT, Schirmer test, MGD grading of plugging and secretions, tear osmolarity, and a composite DED severity score of signs (five dry eye signs, namely TBUT, Schirmer, corneal and conjunctival staining scores, and MGD grade)

Results

• The study population comprised of 535 participants with a mean age of 58 years (females: 81%).
• A total of 479 participants (90%) completed the 6-month follow-up and 486 (91%) completed the 12-month follow-up.
• Of 1070 eyes at baseline, 699 (65%) had no collarettes, 300 (28%) had mild, and 71 (7%) had moderate collarettes. None of the eyes had severe or very severe collarettes.
• Over the period of one year, 67% of eyes showed no change in collarette severity, the collarette severity increased in 19% and decreased in 14% of the eyes. A high agreement was reached for the presence and severity of collarettes between the two eyes, with 63% patients without collarettes in either eye, 33% with collarettes in both eyes, 1% with collarettes in the right eye only, and 2% with collarette in the left eye only. Collarettes were more common patients with facial rosacea (25.0% vs. 17.7%, p =0.05).
• As per a multivariate analysis, collarettes were associated with increased corneal staining (5.06 vs. 4.59, p =0.01), decreased TBUT (3.24 vs. 3.54 s, p =0.01), decreased Schirmer test (7.92 vs. 8.63, p =0.04), more severe eyelid erythema (18.6% vs. 12.2%, p < 0.001), and higher composite DED sign severity (0.51 vs. 0.49, p =0.03).
• The collarettes showed no association with conjunctival staining, MGD grade, or DED symptoms (p ≥ 0.30). Similar findings were observed in comparisons of collarette severity. Subjects with collarettes had lower tear levels of IL-1β (p =0.04), IL-10 (p =∠0.02), and INF-γ (p =∠0.001).

Conclusion

• Patients with moderate-to-severe DED often have collarettes, but most of them do not progress over time.
• Collarettes though associated with worse ocular surface signs, notably eyelid erythema, were not associated with dry eye symptoms.
• These findings may provide the physicians with a guide to treat dry eye patients with collarettes.

Eye. 2026; 40:139–146.