Thi meibography image shows the upper-lid meibomian glands of an 18-year-old male with no prior ocular disease who has worn ortho-k lenses for eight years. Despite being entirely asymptomatic, the glands demonstrate clear tortuosity.

Evidence suggests that long-term orthokeratology wear may influence meibomian gland morphology and tear-film stability—often without overt symptoms. Such changes can develop silently.

It raises a simple clinical question:

Should meibography become a routine part of orthokeratology follow-up?

Seeing changes earlier may help protect long-term ocular surface health.