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Background  To evaluate the correlations between lipid layer thickness (LLT) and morphology and function of the meibomian glands in patients who were diagnosed as meibomian gland dysfunction (MGD) in different age groups.    Methods  Patients who have diagnosed as obstructive MGD were included in this prospective, cross-sectional study. Patients were divided into three groups: young (ages 20–39 years), middle-aged (ages 40–59 years), and older (aged ≥60 years). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and were evaluated for LLT, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT) measurement, invasive TBUT (ITBUT), corneal fluoresceinstaining (CFS) score, eyelid margin abnormalities, Schirmer I test, and MG function and morphology, by using the Keratograph 5 and LipiView interferometer.    Results  Two hundred and nine patients (209 eyes) were included. The median LLT of all patient was 57 nm (IQR, 36.5 nm), and the LLT values were significantly different among the young group (median, 51 nm; IQR, 23.5 nm), middle-aged group (median, 59.5 nm; IQR 46.5 nm) and older group (median, 62 nm; IQR, 42.5 nm) ( P  = 0.033, Kruskal-Wallis test). In regression analyses controlling for confounder factors sex and MG loss, the LLT was positively correlated with age (β = 5.539,  P  = 0.001). There was a negative correlation between LLT and MG dropout in the all ( r  = − 0.527,  P  < 0.001), young ( r  = − 0.536,  P  < 0.001), middle-aged ( r  = − 0.576,  P  < 0.001), and older ( r  = − 0.501,  P  < 0.001) groups. LLT was positively correlated with the MG expressibility in the all ( r  = 0.202,  P  = 0.003), middle-aged ( r  = 0.280,  P  = 0.044) and older ( r  = 0.452,  p  < 0.001) groups, but it was no statistical significance in the young group ( r  = 0.007,  P  = 0.949).    Conclusions  The thickness of LLT was increased with age and significantly correlated with both MG secretion and morphology in middle-aged and older patients with obstructive MGD. LLT measurement is a useful screening tool for detecting obstructive MGD and age as an influential factor should be accounted for when interpreting the meaning of the LLT value.    Trial registration   NCT02481167 ; Registered 25 June, 2015.

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages