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D.R. Korb, J.P. Herman, V.M. Finnemore, J.V. Greiner, M.C. Olson, R.C. Scaffidi; Lid Wiper Epitheliopathy And Associated Dry Eye Symptoms . Invest. Ophthalmol. Vis. Sci. 2004;45(13):100.
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Purpose:The lid wiper is defined as that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking. A new clinical entity, termed lid wiper epitheliopathy, has recently been reported to occur with contact lens wearing. This finding was correlated to symptomatology indicative of dry eye states. The purpose of this study was to evaluate whether lid wiper epitheliopathy was present with non–contact lens wearing subjects who reported dry eye symptoms, but were without any ocular signs. Methods:Subjects were divided into two groups based on the presence or absence of dry eye symptoms. Four symptoms: dryness, grittiness or scratchiness, soreness or irritation, and burning or watering were graded using a questionnaire. Subjects with comfort scores of zero or 1 point were admitted into the asymptomatic group, scores > 5 into the symptomatic group, and scores of 2 to 4 were not admitted. Other criteria for admission to both groups were: FBUT > 10 secs, Schirmer's test with anaesthesia > 10 mm, and no corneal staining. The lid wipers of asymptomatic (n=50) and symptomatic (n=50) subjects were examined following instillation of 2% fluorescein and 1% rose bengal. The examination was conducted at least four hours after awakening. The upper eyelid was everted and lid wiper staining was graded as 0 (no staining), 1 (mild), 2 (moderate) and 3 (severe), rating both the area and intensity of staining. Results:Of the symptomatic subjects, 24% exhibited no staining of the lid wiper; 44%, grade 1 staining; 22%, grade 2; and 10%, grade 3. Of the asymptomatic subjects, 88% exhibited no staining; 8%, grade 1 staining; 4%, grade 2; and none exhibited grade 3. The difference in lid wiper staining between the symptomatic and asymptomatic groups was significant (p < 0.001). The degree of staining also correlated to the severity of symptoms. Conclusions:Lid wiper epitheliopathy, diagnosed by staining with fluorescein and rose bengal, is a frequent finding when symptoms of dry eye are experienced. Lid wiper epitheliopathy was six times more common in subjects reporting symptoms of dry eye than in asymptomatic subjects, and if only grades 2 and 3 were considered, 8 times more common.
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