This is the first case report to show the association between Mooren’s Ulcer and Severe Meibomian Gland Atrophy (SMGA). The question is: what came first the SMGA or the Mooren’s Ulcer?
We are doing a work up to see why this patient lost so many meibomian glands as he is only 52 years old. 
Here is his meibography for the left eye which has the ulcer. He is a stage 3 out of 4 (0 being normal==no gland loss) in his left lower lid.
He has been dealing with this ulcer for 3 months.
His right eye also has severe meibomian gland loss. He used to be a computer programmer. Likely the gland loss started and now something has tipped his immune system over the edge to attack his cornea and lead to this severe melt.
I put a Prokera on him today as his pain got worse after a bandage contact lens was placed for a non-healing cornea. He will come in again in a few days to see how he looks. Saving the meibomian glands are key but very tough.
SLC