Objective:

To construct a composite meibomian gland dysfunction (MGD) score and investigate its associations with corneal nerve parameters, subjective symptoms, and ocular surface signs in patients with dry eye disease (DED).

Approach:

• Study Design: Cross-sectional study including 137 DED patients (274 eyes).
• MGD Composite Score Calculation: Score (0–9) based on gland dropout, expressibility, and meibum quality.
• Assessment Methods: Corneal nerve parameters assessed by in vivo confocal microscopy; symptoms evaluated using OSDI and visual analogue scale.
• Statistical Analysis: Correlation and partial correlation analyses performed.

Key Findings:

• MGD composite score positively correlated with OSDI (r = 0.769, p < 0.01).
• MGD composite score negatively correlated with corneal nerve fiber length (CNFL) (r = −0.709, p < 0.01).
• OSDI strongly correlated with CNFL (r = −0.868, p < 0.01).
• Patients with higher MGD grades exhibited significantly shorter nerve length, more microneuromas, worse TBUT, higher CFS, and greater symptom scores (all p < 0.05).
• Microneuroma count correlated positively with pain, asthenopia, blurred vision, and photophobia.

Interpretation:

The MGD composite score effectively reflects disease severity, and corneal nerve length is associated with the relationship between MGD signs and subjective symptoms.

Limitations:

• Cross-sectional design limits causal inferences.
• Single-center study may affect generalizability.

Conclusion:

The study provides insights into the structural basis for symptom-sign discordance in DED.