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D.R. Korb, J.P. Herman, J.D. Solomon, J.V. Greiner, C.A. Blackie; Lid Wiper Staining and Sequential Fluorescein Instillation . Invest. Ophthalmol. Vis. Sci. 2006;47(13):242.
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The lid wiper (LW) is that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking. Lid wiper epitheliopathy (LWE) may be diagnosed and graded by staining with fluorescein (FL), rose bengal (RB) and lissamine green dyes. The purposes of this study were to investigate (1) whether LWE staining increased with sequential FL instillation and (2) whether RB staining, utilized following 3 sequential FL instillations, contributed to the diagnosis of LWE.
Subjects were divided into asymptomatic (n=50) and symptomatic (n=50) groups based on dry eye symptom scores obtained from the previously described SPEED Questionnaire. FL dye was instilled OD at times 0, 5 and 10 minutes. Grading for FL staining from 0 to grade 3 (severe) was made 1 minute following the instillation of each drop. One minute following the last examination, 1 drop of RB was instilled, and after 1 minute the lid reexamined.
Staining was graded from 0 to 3.0 for both FL and RB. The scores for FL and RB were then averaged for a final score. The average grades for the 50 asymptomatic subjects after instillation of FL at 1, 5 and 10 minutes were 0.13, 0.23 and 0.36. The average grades for the 50 symptomatic subjects after instillation of FL at 1, 5 and 10 minutes were 0.62, 1.36 and 1.60. The difference in prevalence of LW staining between the symptomatic and asymptomatic groups was significant (p<0.001). RB increased staining ≥ 1.0 grade for 4 in the asymptomatic and 7 in the symptomatic group.
The use of sequential applications of FL increased staining for symptomatic subjects from grade 0.62 following a single instillation of FL, to 1.3 after a 2nd instillation and 5 minute residence time, and to 1.60 after a 3rd instillation and 10 minute residence time. RB staining was required for a diagnosis of LWE for 14% of subjects. Sequential instillation of FL enhances and is indicated to diagnose LWE.
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