title: Lid wiper epitheliopathy and dry eye symptoms.
abstract: OBJECTIVE
  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.
authors.affiliation: Korb Associates, Boston, MA, USA. drkorb@aol.com
authors.forename: Donald R
authors.initials: DR
authors.lastname: Korb
authors.forename: John P
authors.initials: JP
authors.lastname: Herman
authors.forename: Jack V
authors.initials: JV
authors.lastname: Greiner
authors.forename: Robert C
authors.initials: RC
authors.lastname: Scaffidi
authors.forename: Victor M
authors.initials: VM
authors.lastname: Finnemore
authors.forename: Joan M
authors.initials: JM
authors.lastname: Exford
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Blackie
authors.forename: Teresa
authors.initials: T
authors.lastname: Douglass
mesh_terms: D000328:Adult; D000368:Aged; D003229:Conjunctival Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology*; D003287:Contrast Media; D015352:Dry Eye Syndromes / Q000150:complications*; D005143:Eyelids; D019793:Fluorescein; D005456:Fluorescent Dyes; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012395:Rose Bengal; D013194:Staining and Labeling
chemical_list: D003287:Contrast Media; D005456:Fluorescent Dyes; D012395:Rose Bengal; D019793:Fluorescein