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D. R. Korb, J. P. Herman, C. A. Blackie, R. C. Scaffidi, J. V. Greiner, J. M. Exford, V. M. Finnemore; Prevalence of Lid Wiper Epitheliopathy in Subjects With Dry Eye Signs and Symptoms. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4640.
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© ARVO (1962-2015); The Authors (2016-present)
Lid wiper epitheliopathy (LWE), detected by ocular staining, is a clinically observable alteration of that portion of the upper eyelid marginal conjunctival epithelium (the lid wiper) that wipes the ocular surface during blinking. The purpose of this study was to investigate the prevalence of LWE in individuals with both symptoms and ocular signs of dry eye.
Subjects were recruited for two groups: symptomatic (n=50) and control (asymptomatic) (n=50). The inclusion criterion for the symptomatic group was the presence of dry eye symptoms as defined by a score <= 10 determined by questionnaire, fluorescein break-up time (FBUT) >= 5 sec, a minimum of grade 1 (scale 0-3) corneal and conjunctival staining with fluorescein (FL), and lissamine green (LG) respectfully, and Schirmer test with anesthesia >= 5 mm. Admission to the control group required the absence of dry eye symptoms, FBUT <= 10 sec, the absence of corneal and conjunctival staining, and Schirmer test <= 10 mm. A drop of a mixture of 2% FL and 1% LG solution were instilled, at time zero and at 5 minutes. One minute later the upper eyelids were everted and the lid wipers of all subjects were examined. LWE was graded (scale 0-3) using the horizontal length and the average sagittal widths of staining for both FL and LG.
For the symptomatic patients, 88% had LWE, of which 25 % was grade 1; 52.3 % grade 2; and 22.7 % grade 3. For the asymptomatic patients, 18 % had LWE of which 77.8 % was grade 1; 22.2 % grade 2; and 0 % grade 3. The difference in the amount and prevalence of lid wiper staining between groups was significant (p >= 0.0001).
The correlation both to dry eye symptoms and signs of dry eye establishes LWE as a sign for the diagnosis of dry eye. The prevalence of LWE >= grade 2 was 16.5 times greater in the symptomatic population than the asymptomatic (4% to 66%) establishes LWE as a diagnostic sign of dry eye states.
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