Lid Margin Sensitivity and Staining in Contact Lens Wear Versus No Lens Wear

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

doi:10.1097/ico.0000000000000448

Cited by 18 publications

(16 citation statements)

References 42 publications

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“…31 Additionally, LWE of the upper lid has been linked to symptomatology whereas the lower lid LWE has not. 32,33 Mechanical manipulation of the eyelid with repeated eversions has also been suggested to increase staining patterns in LWE. 19 It is uncertain if changes to the lid wiper are strictly due to repeated eyelid eversions, alone, or also due to repeated instillations of vital dye.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that LWE has gone unnoticed or underestimated due to a premature observation of the lid wiper post-dye instillation. 6 – 8 , 33 , 37 – 40 Prior to the report to describe the optimal methodology to detect LWE, variability existed as to single 30 , 40 , 41 or double dosing of dye. The present report demonstrates that a double instillation of dye is statistically different than a single-instillation with extended wait times for clinical observation.…”

Section: Discussionmentioning

confidence: 99%

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<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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Lievens

Norgett

Briggs³

et al. 2020

OPTH

View full text Add to dashboard Cite

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“…The mechanical effect of a contact lens has been proposed to alter sensory function and the availability of oxygen to the cornea may also have a role in producing symptoms of dryness . Lid wiper sensitivity to touch was significantly greater than either the tarsal or bulbar conjunctiva for both soft contact lens wearers and non‐wearers . It is not known to what extent lid wiper sensations contribute to rubbing provocation.…”

Section: Discussionmentioning

confidence: 99%

“…50 Lid wiper sensitivity to touch was significantly greater than either the tarsal or bulbar conjunctiva for both soft contact lens wearers and non-wearers. 51 It is not known to what extent lid wiper sensations contribute to rubbing provocation.…”

Section: Dry Eye Rubbing Provocationmentioning

confidence: 99%

Eye rubbing type and prevalence including contact lens ‘removal‐relief’ rubbing

McMonnies

2016

Clinical and Experimental Optometry

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Rubbing-related trauma occurring before contact lens insertion may predispose the cornea to wound healing activities and greater levels of adverse response to contact lens wear. Such adverse responses could predispose the cornea to greater trauma, which occurs in response to rubbing on removal of contact lenses. Strong counselling to avoid eye rubbing is often not an adequate form of management for a significant number of patients with keratoconus. Evidence of relapses indicates the need for better methods of counselling and for them to be repeated regularly. Apart from keratoconus, any other keratectasia, corneal disease or wound healing (including post-surgical) may increase susceptibility to corneal rubbing trauma. Such cases also appear to warrant counselling on avoidance of rubbing.

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“…[3][4][5]13 Several groups [3][4][5]12,14,15 have found evidence to support these findings and have additionally argued that LWE may be the missing key in explaining the discrepancy often noted between signs and symptoms related to dry eye and contact lens discomfort. Interestingly, other groups [16][17][18] have failed to find corroborating evidence. These conflicting results have made it difficult to discern whether LWE is a true pathology or an acceptable physiological variation of the lid wiper.…”

mentioning

confidence: 87%

The Relationship of Lid Wiper Epitheliopathy to Ocular Surface Signs and Symptoms

Yeh

Leung

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. There has been interest in determining whether lid wiper epitheliopathy (LWE) plays a key role in causing ocular discomfort. Conflicting reports have made it difficult to discern whether LWE is more prevalent in certain populations, what characteristics are associated with its severity, and what its role is in symptomology. This cross-sectional study on a large and diverse population attempts to answer these questions.METHODS. Subjects were asked to complete questionnaires related to dry eye and to ocular discomfort. A comprehensive set of ocular surface parameters were assessed, including LWE length and width, tear-film lipid layer thickness, fluorescein tear breakup time (FTBUT), lidparallel conjunctival folds (LIPCOF), and corneal staining. RESULTS.A total of 287 subjects participated in the study. LWE was observed in 45% of the study cohort and was twice as prevalent in Asians than non-Asians (P < 0.005). LWE was more likely to present in contact lens wearers than non-contact lens wearers (P ¼ 0.03). Decreased FTBUT was associated with increased LWE length and width (P < 0.005 and P ¼ 0.01, respectively), although only a small effect size was noted. Presence of LIPCOF was linked with a 0.25-grade increase in LWE width (P ¼ 0.01). Only LWE width was associated with greater symptoms in contact lens wearers.CONCLUSIONS. LWE was associated with decreased tear-film stability, contact lens wear, lid anatomy, and LIPCOF. LWE was not associated with symptoms in non-contact lens wearers. LWE width was associated with greater symptoms in contact lens wearers but was only clinically significant with moderate to severe LWE width.

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Lid Margin Sensitivity and Staining in Contact Lens Wear Versus No Lens Wear

Cited by 18 publications

References 42 publications

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

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

Eye rubbing type and prevalence including contact lens ‘removal‐relief’ rubbing

The Relationship of Lid Wiper Epitheliopathy to Ocular Surface Signs and Symptoms

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