Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Navascues‐Cornago, Maria; Maldonado‐Codina, Carole; Morgan, Philip B.

doi:10.1097/icl.0000000000000230

Cited by 15 publications

(15 citation statements)

References 36 publications

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“…The LWE area found in this study was very similar to the area of upper lid LWE reported with the previous methodology [19]. This semi-automatic image analysis system developed proved to be highly repeatable and hence a step towards truly automated objective grading of LWE.…”

Section: Discussionsupporting

confidence: 68%

“…This study built on the previously reported semi objective image analysis of the LWE [19], providing data on height, height relative to the lid margin width, and width as well as area. The LWE area found in this study was very similar to the area of upper lid LWE reported with the previous methodology [19].…”

Section: Discussionmentioning

confidence: 99%

“…This limits the value in clinical studies due to factors such as the need for larger sample sizes. Only one paper has attempted to analyse LWE using image analysis, however it reports only the area following manual outlining of the lissamine green staining on the lid margin including the line of Marx [19] which is not considered to be part of LWE [3].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Kunnen

Wolffsohn

Ritchey

2018

Contact Lens and Anterior Eye

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Purpose: To validate a semi-objective method of grading lid wiper epitheliopathy (LWE) compared to subjective assessment. Methods:Twenty upper and 20 lower eyelid margins of patients with LWE were photographed after instillation of fluorescein and lissamine green. The images were graded by two observers using a 0-3 grading scale for height (%) and width (mm) of the lid staining. The images were also processed using custom designed software in MATLAB. After manual delineation of the staining area, width and perpendicular height were automatically measured throughout the selected area. The height as a proportion of the lid margin width and width measures were then categorized into the same bins as in the grading scale.Results: Repeatability of the image analysis system showed a mean difference (95% limits of agreement) between repeats of -0.01mm (0.03 and -0.05mm) for LWE height, 0.04mm (1.16 and -1.08mm) for LWE width, and -0. Conclusion:Human observers tend to overestimate the height and underestimate the width of LWE staining. Lid wiper region is not well defined, thus, it might be a difficult process for human observers to judge the stained region as a proportion of the lid wiper total region.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Kunnen

Wolffsohn

Ritchey

2018

Contact Lens and Anterior Eye

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“…A more precise assessment of false negatives might be to quantify each participant's line of Marx staining area individually in order to establish a unique anatomic baseline for later comparison. Challenges arise in attempting such an investigation in the precise identification of the full extent of the line of Marx, given the expected variability in terms of width and location among subjects 16 Therefore, in line with previous studies using alternative semi-automated methodologies,- 9,17,18 it was considered clinically appropriate to use average to provide a basis to detect false negatives in the present study. Korb et al 6 reported the challenge of using paper impregnated strips to deliver adequate dye concentration and volume to uncover the full area of LWE staining.…”

Section: Discussionmentioning

confidence: 77%

“…15,16 The length of the lid margin has also been reported and measures 20.6 ± 1.9 mm. 17 Korb et al 8 used an assessment protocol that grades the horizontal length and width of the lid wiper staining (>10 mm is most severe). The inverted eyelid is curvilinear and mental estimations might make even approximate measurements very difficult.…”

Section: Introductionmentioning

confidence: 99%

<p>Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)</p>

Lievens

Norgett

Briggs³

et al. 2020

OPTH

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Purpose: Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked. Patients and Methods: A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl). Results: There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p<0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl. Conclusion: The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.

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Lid Wiper Epitheliopathy

Efron

2019

Contact Lens Complications

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Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Cited by 15 publications

References 36 publications

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

<p>Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE)</p>

Lid Wiper Epitheliopathy

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