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. 2019 Sep 2;9:12659. doi: 10.1038/s41598-019-49159-0

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Dry eye changes and meibomian gland dysfunction (MGD) parameters during the treatment period in patients with pre-existing dry eye disease (DED). Mean changes in tear breakup time (TBUT) (a), Schirmer test scores (b), corneal staining scores (c), and Ocular Surface Disease Index (OSDI) (d) were used to assess dry eye parameters. Mean changes in lipid layer thickness (LLT) (e), MGD stage (f), lid margin abnormalities (g), meibomian gland expressibility (h), and meibum quality (i) were used as MGD parameters. Data are presented as mean values ± standard error of the mean (SEM). P-values are presented next to all graphs for each study period, indicating the results of statistical analyses among the 3 groups for that period using analysis of variance; ^¶P-value indicates the overall difference analysis throughout the study period by generalized estimating equation; ^†indicates a statistically significant difference between groups 1 and 2 per post hoc analysis; ^‡indicates a statistically significant difference between groups 1 and 3 per post hoc analysis; ^§indicates a statistically significant difference between groups 2 and 3 per post hoc analysis.