Incomplete rather than complete nasolacrimal duct obstruction Is strongly associated with meibomian gland dysfunction in postmenopausal women with PANDO: a cross-sectional study

BackgroundAlthough postmenopausal women with primary acquired nasolacrimal duct obstruction (PANDO) frequently present with concurrent meibomian gland dysfunction (MGD), and PANDO is known to contribute to ocular surface inflammation, the specific factors driving MGD in these patients remain unclear. This study aimed to identify and assess key demographic, clinical, and hormonal factors associated with MGD.MethodsThis prospective study included 272 postmenopausal women (180 with PANDO, 92 controls). All underwent standardized assessments: meibography (Keratograph 5 M) for gland loss, slit-lamp MG evaluation, and the Ocular Surface Disease Index (OSDI) questionnaire. Multivariable regression identified independent MGD risk factors, adjusting for age, menopause duration, obstruction completeness, disease duration, and dacryocystitis. Exploratory tear cytokine (n = 71) and serum hormone (n = 98) analyses were performed.ResultsAfter adjustment, incomplete obstruction showed the strongest independent association with severe upper eyelid MG loss (95% CI: 2.48–8.82, p < 0.001) and a 2.02-fold increased odds of worse lower eyelid meibum quality (95% CI: 1.13–3.63, p = 0.019). A longer duration of PANDO was associated with reduced odds of expressibility impairment (OR = 0.96 per year, p = 0.027). Higher non-invasive tear meniscus height predicted longer tear breakup time (B = 2.85, p < 0.001). Several univariately significant factors lost independence in multivariable models.ConclusionIncomplete PANDO is the principal factor associated with severe, often asymptomatic MGD in postmenopausal women in this cross-sectional analysis. Clinical evaluation should extend beyond epiphora. Routine meibography is recommended to detect silent gland atrophy and guide ocular surface preservation strategies.