A new study found patients with lichen planopilaris (LPP)—a chronic lymphocyte-mediated disorder that selectively involves hair follicles, leading to cicatricial alopecia—had a statistically significant lower tear break-up time (TBUT). Both meibomian gland quality score and expressibility were higher in patients with LPP. Researchers believe such results indicate meibomian gland dysfunction (MGD) as a likely cause for the dry eye symptoms in these patients, with both the LPP and MGD arising through autoimmune mechanisms.

Some similarities exist in the mechanisms of immune privilege of the hair follicle and eye, the researchers note. Meibomain glands are part of the skin’s sebaceous gland network and are thus responsive to the same inflammatory reactions at work in hair loss. Other studies have investigated ocular findings in several skin diseases with immune dysfunction such as rosacea, psoriasis and alopecia areata.

The recent study, published in Cornea, focused on ocular surface parameters in patients with LPP. The study compared 23 patients with LPP to 23 members of a control group. Researchers used the Lichen Planopilaris Activity Index (LPPAI) to quantify the signs and symptoms of LPP and assessed MGD by expressibility and quality.

The study also found a significant but weak correlation between the LPPAI and TBUT. Researchers suggest that the severity of LPP could possibly be an important factor for the development of dry eye.

The Schirmer test score did not differ between the two groups, and the study attributed the discrepancy between the TBUT scores and the results of the Schirmer test to the small sample size of the study.

Gheisari M, Dadkhahfar S, Fadakar K et al. Ocular surface findings in patients with lichen planopilaris. Cornea. 2018. 37(9):1151-4.