J Korean Ophthalmol Soc.  2018 Aug;59(8):718-723. 10.3341/jkos.2018.59.8.718.

Lid Wiper Epitheliopathy in Patients with Dry Eye Refractory to Conventional Medical Treatment

• Huh J
• Woo IH
• Eom Y
• Kang SY
• Kim HM
• Song JS

• KMID: 2418497
• DOI: http://doi.org/10.3341/jkos.2018.59.8.718

Abstract

PURPOSE
We evaluated the effects of lid wiper epitheliopathy on the clinical manifestations of dry eye in patients refractory to conventional medical treatment.
METHODS
Forty-six patients (46 eyes) completed the subjective Ocular Surface Disease Index (OSDI), and we obtained objective measures including the tear break-up time (TBUT), the National Eye Institute (NEI) corneal staining score, tear osmolarity, and lid wiper epitheliopathy as revealed on photographs taken using a yellow filter after fluorescein instillation. The images were graded using the Korb B protocol.
RESULTS
The mean OSDI score was 48.06 ± 21.19; 34 patients (73.9%) were had scores ≥33. Lid wiper epitheliopathy was evident in 41 (89.1%), and the epitheliopathy grade and OSDI score were correlated (r = 0.56, p < 0.01). The NEI score was also positively correlated with the OSDI score (r = 0.54, p < 0.01), but the mean value was low (1.59 ± 2.13). The OSDI score did not correlate significantly with either the TBUT or tear osmolarity (r = −0.16, p = 0.279; r = 0.16, p = 0.298, respectively).
CONCLUSIONS
Lid wiper epitheliopathy was present in about 90% of patients with dry eye who visited our tertiary hospital, and a significant correlation was evident between the epitheliopathy grade and the OSDI score.

Keyword

Correlation; Dry eye; Lid wiper epitheliopathy; Medical; Refractory

MeSH Terms

Fluorescein
Humans
National Eye Institute (U.S.)
Osmolar Concentration
Tears
Tertiary Care Centers
Fluorescein

Figure

• 

  Figure 1 Age distribution. Age of 20-29 (n = 20) (43.5%), age of 30-39 (n = 14) (30.4%), age of 40-49 (n = 5) (10.9%), and age of ≥50 (n = 7) (15.2%).

• 

  Figure 2 Ocular Surface Disease Index (OSDI) ocular disability grading distribution. Normal (0-12) (n = 1) (2.2%), Mild (13-22) (n = 4) (8.7%), Moderate (23-32) (n = 7) (15.2%), and Severe (≥33) (n = 34) (73.9%).

• 

  Figure 3 Tear osmolarity distribution. Under 300 (n = 28) (60.9%), 301-308 (n = 12) (26.1%), 309-312 (n = 2) (4.3%), and Over 312 (n = 4) (8.7%).

• 

  Figure 4 Lid wiper epitheliopathy grading distribution. 0 (n = 5) (10.9%), 1.0 (n = 1) (2.2%), 1.5 (n = 4) (8.7%), 2.0 (n = 11) (24.0%), 2.5 (n = 5) (10.9%), and 3.0 (n = 20) (43.5%). *By Korb protocol B, 2010.

• 

  Figure 5 Correlation of Ocular Surface Disease Index (OSDI) score with other variables. (A) National Eye Institute (NEI) fluorescein staining scale, (B) lid wiper epitheliopathy grading, (C) tear osmolarity, and (D) tear break-up time (TBUT). *Simple linear regression test.

• 

  Figure 6 One representative case with lid wiper epitheliopathy. A patient complained of sustained dry eye symptoms, whose Ocular Surface Disease Index (OSDI) score was 56.2. There was no corneal staining under slit lamp examination (A). However, prominent lid wiper epitheliopathy was noted on the upper eyelid (B).

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