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J.P. Herman, D.R. Korb, J.V. Greiner, R.C. Scaffidi, C.A. Blackie; Treatment of Lid Wiper Epitheliopathy With a Metastable Lipid Emulsion or a Corticosteroid . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2017.
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Purpose: Lid wiper epitheliopathy (LWE), a clinically observable alteration of that portion of the marginal conjunctival epithelium that wipes the ocular surface during blinking, is diagnosed by vital staining. LWE occurs with patients presenting with dry eye symptoms, both in the presence and absence of conventional ocular signs. The purpose of this study was to evaluate the efficacy of 2 treatment regimes for LWE: 1.0 % prednisolone acetate eye drop and a metastable lipid emulsion eye drop. Methods: Subjects with LWE were divided into two treatment groups: (1) a steroid group (n=30) treated with 1.0% prednisolone acetate (Pred Forte®, Allergan, Inc., Irvine, CA) qid x 30 days and (2) a lipid group treated with a metastable lipid emulsion eye drop (SootheTM, Alimera Sciences, Inc., Alpharetta, GA) qid x 30 days. Inclusion criteria included: the presence of > grade 1.5 LWE determined by staining with 2% fluorescein and 1% lissamine green and a symptom score >10 out of a possible 24 points using a custom symptoms(SPEED) questionnaire (Korb et al: Eye & Contact Lens 2005) to grade four symptoms. The upper eyelid was everted and lid wiper (LW) staining was graded as 0 (no staining), 1 (mild), 2 (moderate) and 3 (severe) [Korb et al: Eye & Contact Lens 2005]. After the treatment, examination of the LW and the questionnaire were repeated. Results: The mean symptom scores prior to treatment were 13.2 points for the steroid group and 12.6 points for the lipid group, and following treatment 4.9 points for the steroid group and 6.2 points for the lipid group. The difference in symptom scores following treatment was significant for both groups (p < 0.01 for the steroid group and p < 0.01 for the lipid group). The mean LWE staining grades prior to treatment were 2.1 for the steroid group and 1.9 for the lipid group, and following treatment 0.9 for the steroid group and 0.8 for the lipid group. The difference in LWE staining grades following treatment was significant for both groups (p < 0.01 for the steroid group and p < 0.01 for the lipid group). Conclusions: Treatment with either 1.0% prednisolone acetate or the metastable lipid emulsion was effective in diminishing the severity of the LWE and the associated symptoms. These results suggest a mechanical etiology is associated with LWE. The duration of the decrease in LWE upon cessation of treatment was not addressed in this study.
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