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The Effect of Contact Lens Wear on the Cellular Morphology of the Lid Wiper Area

Alghamdi, Waleed M., PhD1,2,3*; Markoulli, Maria, PhD, FAAO2; Papas, Eric B., PhD, FAAO2

Optometry and Vision Science: June 2018 - Volume 95 - Issue 6 - p 491–497
doi: 10.1097/OPX.0000000000001224
Original Investigations

SIGNIFICANCE This cross-sectional study presented a link between contact lens wear and changes on the cellular morphology characteristics of the lid wiper (LW) epithelium, which was not visible by LW staining.

PURPOSE The aim of this study was to establish if the duration of contact lens (CL) wear affects the cellular morphology of the LW epithelium.

METHODS This was a cross-sectional study of 100 individuals with different exposures to CL wear: short, moderate, and long experience of CL wear; previous CL wearers; and nonwearers (NWs) as controls. Impression cytology samples were collected from the central upper lid margin (LW area). After fixing, samples were stained with periodic acid–Schiff and haematoxylin for cell morphology analysis and subsequently graded according to the Nelson 0- to 3-point scale. Lid wiper staining was assessed with the aid of lissamine green and graded using the Korb (0- to 3-point) scale. One-way Kruskal-Wallis analysis followed by the Dunn multiple-comparisons test was used for statistical comparison.

RESULTS The Nelson grade for LW epithelium morphology was significantly different between groups (P = .003). Abnormal epithelial morphology as defined by grade 2 or 3 was evident in 66.7% of CL wearers with short experience and 76.5% of CL wearers with moderate experience. This was significantly higher than NWs of whom only 21.5% showed greater than grade 1 (P = .02 and .005, respectively). There was no significant difference between NWs and other groups. Lid wiper staining did not significantly differ between groups (P = .50) or correlate with the Nelson grade (Spearman r = 0.02, P = .08).

CONCLUSIONS Metaplasia of the LW epithelium was significantly greater in the early to moderate stages of CL. This supports the view that mechanical irritation is responsible for LW changes in CL wear. Ceasing CL wear seems to lead to recovery. Lid wiper staining did not reflect the underlying morphological changes.

1Department of Optometry, College of Applied Medical Science, Qassim University, Qassim, Saudi Arabia

2School of Optometry & Vision Science, University of New South Wales, Sydney, New South Wales, Australia

3Brien Holden Vision Institute, Sydney, New South Wales, Australia *

Submitted: August 2, 2017

Accepted: April 2, 2018

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: WMA; Data Curation: WMA; Formal Analysis: WMA, MM; Investigation: WMA; Methodology: WMA, MM, EBP; Project Administration: MM, EBP; Supervision: MM, EBP; Validation: MM, EBP; Writing – Original Draft: WMA; Writing – Review & Editing: MM, EBP.

WMA was a PhD candidate at UNSW Sydney when the study was conducted; he is now an employee at the Department of Optometry and Vision Science, Qassim University, Saudi Arabia.

Part of this study was presented at 2016 TFOS Conference, September 7–10, 2016, in Montpellier, France (no. 66).

© 2018 American Academy of Optometry