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H. Pult, C. Purslow, M. Berry, P. J. Murphy; Clinical Signs of Discomfort in Contact Lens Wearers. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4842. doi: https://doi.org/.
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Lid wiper epithiolopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in contact lens wearers. This study investigates the relationship of LWE, LIPCOF and objective tests of the ocular surface and tear film to discomfort in soft contact lens wearers.
Comfort was evaluated using the Contact Lens Dry Eye Questionnaire (CLDEQ). Pre-lens break-up time (PLBUT), ocular hyperaemia, corneal staining, LWE and LIPCOF were assessed in the right eyes of 61 (23M, 38F; mean age=32.1±11.4yrs) experienced lens wearers. The tear film was sampled using Schirmer strips pressed onto the temporal conjunctiva, and from harvested contact lenses. Mucins were assessed in dot-blots and Western blots after electrophoresis on 1% agarose or 4-12% NuPAGE Gels. Non-parametric analyses were used to study differences between groups, and correlations between objective tests, mucins and symptoms.
38 subjects were classified asymptomatic and 23 symptomatic by the CLDEQ. LWE and LIPCOF were significantly increased in the symptomatic group (p<0.03). No significant differences were found between groups for PLBUT, corneal staining or hyperaemia (0.29<p<0.88). Significant correlations were found between LWE and both temporal LIPCOF (r=0.67, p<0.001), and nasal LIPCOF (r=0.39, p<0.001), and between LWE and bulbar hyperaemia (r=0.28, p<0.001). The positive and negative predictive values (PPV/NPV/cut-off value) of temporal LIPCOF was 56.9%/77.1%/≥2; of nasal LIPCOF 70.7%/75.0%/≥1; of LIPCOF Sum 79.8%/86.5%/≥2; and of LWE 53.1%/81.1%/≥1.MUC5AC reactivity was significantly decreased in symptomatics (p=0.050). MUC4 was correlated to temporal LIPCOF and LWE, (r=-0.47 and -0.46; p<0.01). MUC16 and MUC5AC correlated with corneal staining (0.36<r<0.53; p<0.04).
Symptomatic contact lens wearers exhibit significantly more LWE and LIPCOF, and decreased MUC5AC reactivity. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. Increased friction might follow from insufficient, or an altered balance of, mucins at the ocular surface.
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