Long Term Treatment of Lid Wiper Epitheliopathy With an Oil–In–Water Emulsion Lubricant Eye Drop

Abstract

Purpose: : (1) To evaluate the efficacy of a corticosteroid and an oil–in–water metastable emulsion for the initial treatment of lid wiper epitheliopathy (LWE) and associated symptoms. (2) To evaluate the long–term efficacy of a new oil–in–water metastable emulsion for the treatment of LWE.

Methods: : LWE was evaluated using previously described staining and grading techniques. Symptoms were evaluated using the previously described SPEED questionnaire. Subjects with LWE scores ≥ .75 (0–3.0) and symptom scores ≥ 7 (0–24) were admitted. Corneal and conjunctival fluorescein staining was graded from 0 to 3.0. Subjects were randomized to three groups; one (n=40) was treated with the corticosteroid, Lotemax® (Bausch and Lomb, Inc.); the second group (n=40) with an oil–in–water metastable emulsion, Soothe^TM Emollient Eye Drops (Alimera Sciences, Inc.); and the third (n=30) was not treated and served as a control. Following the treatment phase (5–10 weeks), a maintenance phase (1 year) was initiated with 46 subjects who achieved ≥ 50% improvement with both LWE findings and symptoms. The subjects were instructed to apply the oil–in–water emulsion 1 to 3 times per day and were evaluated quarterly for LWE, symptoms, and staining for one year.

Results: : Both the corticosteroid and oil–in–water emulsion regimens were equally effective in minimizing or eliminating dry eye findings and symptoms during the treatment phase. There was a mean decrease in grades for LWE findings and symptoms ≥ 50%; for both groups, the control group did not improve (p < 0.01). The maintenance phase of one year was completed by 46 subjects. Of the 46, 39 maintained the improvement from the treatment phase (p < 0.01). The mean decrease in corneal and conjunctival staining for the treatment phase was similar and ≥ 35% for both groups. This improvement continued during the maintenance phase.

Conclusions: : Both the corticosteroid and oil–in–water emulsion regimens were effective in minimizing or eliminating LWE findings and symptoms during the treatment phase of 5–10 weeks. The oil–in–water emulsion regimen without the use of corticosteroids was effective in controlling LWE findings and associated symptoms and minimizing corneal and conjunctival staining in the maintenance phase of 1 year.

Keywords: cornea: tears/tear film/dry eye • corticosteroids • eyelid