Dry Eye/Meibomian Gland Dysfunction

Grade	1	2	3	4
Discomfort severity	Mild episodic	Moderate	Severe frequent	Severe disabling
Visual symptoms	None	Annoying or episodic activity limiting	Annoying chronic or chronic activity limiting	Constant or disabling
Conjunctival injection	None to mild	None to mild	+/-	+/++
Conjunctival staining	None to mild	Variable	Moderate to marked	Marked
Corneal staining	None to mild	Variable	Marked central	Severe punctate erosions
Corneal/tear signs	None to mild	Mild debris, decreased meniscus	Filamentary keratitis, mucus clumping, increased tear debris	Filamentary keratitis, mucus clumping, increased tear debris, ulceration
Lid/MG	MGD variably present	MGD variably present	Frequent	Trichiasis, keratinization, symblepharon
TBUT	Variable	<=10	<=5	Immediate
Schirmer score	Variable	<=10	<=5	<=2

Meibomian Gland Dysfunction (MGD) Staging

Stage	MGD Grade	Symptoms	Corneal Staining
1	+ (minimally altered expressibility and	None	None
2	++ (mildly altered expressibility and secretion quality)	Minimal to mild	None to limited
3	+++ (moderately altered expressibility and secretion quality)	Moderate	Mild to moderate; mainly peripheral
4	++++ (severely altered expressibility and secretion quality)	Marked	Marked; central in addition
“Plus” disease – co-existing or accompanying disorders of the ocular surface and/or eyelids