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Prevalence of Upper- and Lower-Lid-Wiper Epitheliopathy in Contact Lens Wearers and Non-wearers

Shiraishi, Atsushi M.D., Ph.D.; Yamaguchi, Masahiko M.D., Ph.D.; Ohashi, Yuichi M.D., Ph.D.

doi: 10.1097/ICL.0000000000000040

Objective: To report lid-wiper epitheliopathy (LWE)-like staining at the lower eyelid margin (lower-LWE) and to determine the prevalence of LWE (upper-LWE) and lower-LWE in contact lens (CL) wearers and non-CL wearers.

Methods: Four hundred forty-three eyes of 229 non-CL wearers, 405 eyes of 208 soft CL wearers, and 135 eyes of 71 rigid gas permeable CL wearers were studied. Lissamine green and fluorescein (FL) staining were used to assess the degree of LWEs, tear break-up time (BUT), and cornea-conjunctival staining (FL-S). The correlations between the prevalence of LWEs and the other factors were evaluated.

Results: The prevalence of lower-LWE was significantly higher (39.5%) than upper-LWE in non-CL wearers (upper-LWE; 12.0%; P<0.001). The prevalence of both upper- and lower-LWE were significantly correlated with age and FL-S, but not sex and BUT, in non-CL wearers. The prevalence of both upper- and lower-LWE was significantly higher in younger than older subjects (P<0.001). Upper- and lower-LWE were detected in a higher percentage of CL wearers than in non-CL wearers (P<0.001).

Conclusion: Our results indicate that examination of the lower eyelid margin would be preferable to that of the upper eyelid margin in studies of LWE.

Departments of Ophthalmology (A.S., M.Y., Y.O.), Stem Cell Biology (A.S.), and Infectious Diseases (Y.O.), Ehime University Graduate School of Medicine, Toon, Japan.

Address correspondence to Atsushi Shiraishi, M.D., Ph.D., Department of Ophthalmology, Ehime University Graduate School of Medicine, Shitsukawa, Toon 791-0295, Japan; e-mail:

The authors have no funding or conflicts of interest to disclose.

Accepted April 25, 2014

© 2014 Contact Lens Association of Ophthalmologists, Inc.