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Prevalence of Lid Wiper Epitheliopathy in Subjects With Dry Eye Signs and Symptoms

Korb, Donald R OD*; Herman, John P OD†; Blackie, Caroline A OD, PhD*; Scaffidi, Robert C MD‡; Greiner, Jack V OD, PhD§∥; Exford, Joan M OD*; Finnemore, Victor M OD*

doi: 10.1097/ICO.0b013e3181ba0cb2
Clinical Science

Purpose: The purpose of this study was to investigate the prevalence of lid wiper epitheliopathy (LWE) in patients diagnosed with dry eye disease (DED).

Methods: Patients were recruited for two groups. Inclusion criteria for the DED group (n = 50) was: a score greater than 10 with the Standard Patient Evaluation of Eye Dryness questionnaire, fluorescein break-up time 5 seconds or less, corneal and conjunctival staining with fluorescein, lissamine green Grade 1 or greater (scale 0-3), and Schirmer test with anesthesia 5 mm or less. For the asymptomatic group (n = 50), inclusion criteria were: no dry eye symptoms, fluorescein break-up time 10 seconds or greater, no corneal or conjunctival staining, and Schirmer test 10 mm or greater. Sequential instillations (n = 2, 5 minutes apart) of a mixture of 2% fluorescein and 1% lissamine green solution were used to stain the lid wipers of all patients. LWE was graded (scale 0-3) using the horizontal lid length and the average sagittal lid widths of the stained wiper.

Results: In symptomatic patients, 88% had LWE, of which 22% was Grade 1, 46% Grade 2, and 20% Grade 3. In asymptomatic patients, 16% had LWE, of which 14% was Grade 1, 2% was Grade 2, and 0% Grade 3. The difference in prevalence of lid wiper staining between groups was significant (P < 0.0001).

Conclusions: The prevalence of LWE was six times greater for the DED group and the prevalence of LWE Grade 2 or greater was 16 times greater for the DED group than for the control group. These data further establish LWE as a diagnostic sign of dry eye disease.

Author Information

From the *Korb Associates, Boston, MA; †Pittsfield Eye Associates, Pittsfield, MA; ‡Tufts Medical School, Boston, MA; §Schepens Eye Research Institute, Boston, MA; and ∥Department of Ophthalmology, Harvard Medical School, Boston, MA.

Received for publication March 24, 2009; revision received June 22, 2009; accepted July 30, 2009.

Supported by Korb Associates, Boston, MA.

Reprints: Caroline A. Blackie, 400 Commonwealth Avenue, Unit #2, Boston, MA 02215 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.