Meibomian gland dysfunction (MGD) manifests through two main clinical presentations, characterized by the meibomian gland (MG) ductal obstruction or acinar dropout. While previous research has predominantly associated MGD pathogenesis with hyperkeratinization-related MG ductal obstruction and subsequent acinar atrophy, recent cases have shown significant functional acinar loss in the absence of apparent ductal keratinization or blockage. The deterioration of either MG obstruction or dropout exacerbates the condition of the other, suggesting an independent yet interconnected relationship that perpetuates the vicious cycle of MGD. Understanding the distinct pathological features of MG obstruction and dropout is crucial for delineating their etiology and identifying targeted therapeutic strategies. This review explores the nuanced interrelations of MG obstruction and dropout, elucidating potential pathological mechanisms to establish a foundation for early MGD diagnosis and intervention.

Abstract: To report a palliative and alternative surgical procedure, allogeneic sclera graft combined with autologous conjunctival flap (ASGACF), employing to repair the large emergent corneal perforation. The detail protocol of the surgical procedure was characterized and four representative cases were reviewed. An allogeneic sclera graft and recipient bed were prepared as the traditional penetrating keratoplasty (PK). And then sutured the sclera graft to the bed with 10-0 nylon suture and covered with a pedicled autologous conjunctival flap in half size. In the follow-up, the ASGACF repaired all of the corneal perforations and restored the integral walls of eyeballs, in spite of one who underwent a second surgery. This surgical procedure provided a palliative method to repair the large emergent corneal perforation while there is the lack of a corneal graft.