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DR Korb, JV Greiner, JP Herman, E Hebert, VM Finnemore, JM Exford, T Glonek, M Olson; Lid Wiper Epitheliopathy and Associated Dry Eye Symptoms in Contact Lens Wearers . Invest. Ophthalmol. Vis. Sci. 2002;43(13):55.
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Purpose:To evaluate whether dry eye symptoms, occurring while wearing contact lenses, were associated with the epitheliopathy of that portion of the marginal conjunctiva of the upper eyelid (the lid wiper) that acts as a wiping surface over the ocular or contact lens surfaces. Methods:The lid wiper of asymptomatic (n=75) and symptomatic (n=30) hydrogel contact lens wearers was examined following instillation of 2% fluorescein and 1% rose bengal. Symptoms of dryness, grittiness or scratchiness, soreness or irritation, burning or watering were graded using a questionnaire. After five hours of contact lens wearing, the upper eyelid was everted and the lid wiper staining was graded as 0 (no staining), 1 (mild), 2 (moderate) and 3 (severe) as classified using a scale rating both the area and intensity of staining as demonstrated by color photographic analysis. Differences in staining were determined using the chi-square test. Results:The asymptomatic lens wearers demonstrated no staining in 84%; grade 1 staining, 11%; grade 2, 3%; and grade 3, 3%. The symptomatic lens wearers demonstrated no staining in 27%; grade 1 staining, 37%; grade 2, 20%; and grade 3, 17%. The difference in lid wiper staining between the asymptomatic and symptomatic groups was significant (p < 0.0001). The degree of staining also correlated to the severity of symptoms that included dryness, grittiness or scratchiness, soreness or irritation, burning or watering. Conclusion:This study describes a new clinical entity, lid wiper epitheliopathy, a clinically observable alteration of the epithelium of that portion of the marginal conjunctiva that wipes the ocular surface. Lid wiper epitheliopathy, diagnosed by staining with fluorescein and rose bengal, is a frequent finding with wearers of soft contact lenses who experience symptoms of dry eye. This finding was more than four times more common with soft contact lens wearers who report symptoms of dry eyes within the first 4 hours of wearing than with soft contact lens wearers who are asymptomatic.
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