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Lid Wiper Epitheliopathy and Dry Eye Symptoms

Korb, Donald R. O.D.; Herman, John P. O.D.; Greiner, Jack V. O.D., D.O., Ph.D.; Scaffidi, Robert C. B.S.; Finnemore, Victor M. O.D.; Exford, Joan M. O.D.; Blackie, Caroline A. O.D., Ph.D.; Douglass, Teresa B.A.

Eye & Contact Lens: Science & Clinical Practice: January 2005 - Volume 31 - Issue 1 - p 2-8
doi: 10.1097/01.ICL.0000140910.03095.FA

Objectives. The lid wiper is defined as that portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking. The purpose of this study was to investigate whether lid wiper epitheliopathy occurred with patients who reported dry eye symptoms, yet had normal fluorescein breakup time (FBUT) and Schirmer test values and an absence of fluorescein corneal staining.

Methods. One hundred patients were divided into two groups based on the presence or absence of dry eye symptoms, as determined with the Standard Patient Evaluation of Eye Dryness questionnaire. Other criteria for admission to both groups were FBUT of 10 seconds or more, Schirmer test value of 10 mm or more, and absence of fluorescein corneal staining. After instillation of fluorescein and rose bengal dyes, the lid wipers of 50 asymptomatic and 50 symptomatic patients were graded for staining from grade 0 (absent) to grade 3 (severe).

Results. Of the symptomatic patients, 76% had staining of the lid wiper: 44%, grade 1; 22%, grade 2; and 10%, grade 3. Of the asymptomatic patients, 12% had staining; 8%, grade 1; 4%, grade 2; and 0%, grade 3. The difference in prevalence of lid wiper staining between the symptomatic and asymptomatic groups was significant (P<0.0001).

Conclusions. Lid wiper epitheliopathy, diagnosed by staining with fluorescein and rose bengal dyes, is a frequent finding when symptoms of dry eye are experienced in the absence of routine clinical dry eye findings.

From Korb Associates (D.R.K., V.M.F., J.M.E., C.A.B., T.D.), Boston, MA; Pittsfield Eye Associates (J.P.H.), Pittsfield, MA; the Department of Ophthalmology (J.V.G.), Harvard Medical School, Boston, MA; and Schepens Eye Research Institute (J.V.G., R.C.S.), Boston, MA.

Supported in part by Ocular Research of Boston (ORB), Boston, MA. Editorial space constraints required the elimination of most of the references.

This study was originally presented in part at the International Society of Contact Lens Research, Palma de Mallorca, Spain, September 9, 2003 and at the 23rd Biennial Cornea Research Conference, Schepens Eye Research Institute, Boston, MA, October 4, 2003.

Address correspondence and reprint requests to Dr. D.R. Korb, 100 Boylston Street, Suite 550, Boston, MA 02116; e-mail:

Accepted June 22, 2004.

© 2005 Lippincott Williams & Wilkins, Inc.