Lid Wiper Epitheliopathy

Efron, Nathan

doi:10.1016/b978-0-7020-7611-4.00005-4

Cited by 6 publications

(22 citation statements)

References 62 publications

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“…In addition, as stated in many publications in the literature, it may be that the impression cytology from the lid margin cannot be performed as optimally as the conjunctival impression cytology. 21,31,36 Therefore, we think that the cytology of lid margin still needs to be clarified and new calcifications need to be developed, as Efron et al 37 Our study is the first study evaluating eyelid cytomorphology in CCH patients. However, the findings presented are preliminary.…”

Section: Discussionmentioning

confidence: 93%

Impression cytology and meibomian glands in conjunctivochalasis

Muhafız

Bozkurt

Erten

2021

European Journal of Ophthalmology

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Purpose: To evaluate the tear parameters, meibomian glands and lid margin and tarsal conjunctival impression cytology in patients with conjunctivochalasis (CCH). Methods: The study included 57 patients diagnosed with CCH and 35 healthy volunteers. Tear break-up time (TBUT) was measured and Schirmer test was performed. Meibomian gland morphologies, dropout rates, and meiboscores were evaluated using meibography. Finally, impression cytology samples were taken by pressing the impression filters on the lower lid margin and lower tarsal conjunctiva. The samples were evaluated according to the Nelson grading system. Results: Schirmer test was longer and TBUT was shorter in the study group ( p = 0.035 and p < 0.001, respectively). The median of meibomian gland dropout rate was 33.45% (Interquartile range [IQR]; 23.17%–49.75%) and 18.80% (IQR; 12.35%–26.50%) in the study and control groups, respectively ( p < 0.001). There was no significant difference in terms of lid-margin cytology between the two groups ( p = 0.481). In tarsal conjunctiva cytology, the median value of Nelson grade of the study group was 2 (IQR; 1–2) and that of the control group was 1 (IQR; 1–2) ( p = 0.040). When Nelson grade-2 and above was accepted as the pathological limit, it was found that 27.5% of the study group and 15.2% of the control group showed pathological findings ( p = 0.204). Conclusions: In patients with CCH, damage occurs in the tarsal conjunctiva with the effects of redundant conjunctival folds. In these patients, atrophy occurs in the meibomian glands and tear stability is impaired. Therefore, CCH should not be overlooked in clinical practice.

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Section: Discussionmentioning

confidence: 93%

Impression cytology and meibomian glands in conjunctivochalasis

Muhafız

Bozkurt

Erten

2021

European Journal of Ophthalmology

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“…T he lid wiper is defined as the portion of the marginal conjunctiva of the upper/lower eyelids that wipes the ocular surface during blinking. [1][2][3] Histologically, the lid wiper consists of stratified epithelium with a conjunctival structure of cuboidal cells, parakeratinized cells, and goblet cells, forming an epithelial elevation of typically about 100mm initial thickness. 3,4 The goblet cells of lid wiper are observed in both superficial and deep layers of the epithelium and along crypts, known as "goblet cell crypts," which are connected to the surface.…”

mentioning

confidence: 99%

“…[1][2][3] Histologically, the lid wiper consists of stratified epithelium with a conjunctival structure of cuboidal cells, parakeratinized cells, and goblet cells, forming an epithelial elevation of typically about 100mm initial thickness. 3,4 The goblet cells of lid wiper are observed in both superficial and deep layers of the epithelium and along crypts, known as "goblet cell crypts," which are connected to the surface. [3][4][5] These goblet cells secrete MUC5AC, a soluble gel-forming mucin, into the tear film.…”

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confidence: 99%

“…The secreted mucins form a hydrodynamic fluid layer between the lid wiper and the cornea/bulbar conjunctiva and decrease friction during blinking. 3,4 Lid wiper epitheliopathy (LWE) is the term used to describe an epitheliopathy of the lid wiper, [1][2][3] and it is theorized that it is related to the increased friction that occurs during the blinking process, similar to superior limbic keratopathy [6][7][8] and filamentary keratitis. [9][10][11] Although LWE was first reported in contact lens wearers, it is also reportedly observed in noncontact lens wearers, especially patients with dry eye.…”

mentioning

confidence: 99%

“…[9][10][11] Although LWE was first reported in contact lens wearers, it is also reportedly observed in noncontact lens wearers, especially patients with dry eye. [1][2][3]12,13 It has been reported that the severity of LWE is correlated with dry eye-related symptoms and parameters, such as tear film breakup time, tear meniscus height, and conjunctivocorneal epithelial staining. [13][14][15] The pathophysiology of dry eye consists of 3 essential mechanisms, that is, 1) tear film instability, 2) increased friction during blinking, and 3) inflammation associated with mechanisms 1) and 2).…”

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confidence: 99%

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Clinical Factors for Determining the Severity of Lid Wiper Epitheliopathy in Dry Eye

Katô¹,

Yokoi²,

Watanabe³

et al. 2021

Cornea

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Purpose: Lid wiper epitheliopathy (LWE) is an epitheliopathy of the marginal conjunctival portion of the eyelids that wipes the ocular surface during blinking. Although LWE is often observed in patients with dry eye, the factors determining LWE severity in dry eye remain unknown. Therefore, we investigated the relationship between LWE, tear abnormalities, and blinks in dry eye.Methods: This study involved 76 eyes of 76 female patients with dry eye (mean age: 57.2 yrs). In all eyes, tear meniscus radius, spread grade (SG) of the tear film lipid layer (ie, SG 1-5, with 1 being the best), fluorescein breakup time (FBUT), fluorescein breakup pattern, corneal and bulbar conjunctival epithelial damage (CED: 15 points maximum; CjED: 6 points maximum, respectively), upper eyelid LWE grade (3 points maximum), and Schirmer 1 test were evaluated. Blink rate, palpebral aperture height, upper eyelid opening/closing-phase amplitude, upper eyelid opening/closing-phase duration, and upper eyelid opening/closing-phase maximum velocity were measured by the use of a custom-made high-speed blink analyzer. Finally, the factors that determine the LWE grade were investigated by multiple regression analysis, in which the parameters were chosen using the stepwise procedure.Results: Significant correlations were found between LWE grade and tear meniscus radius, SG, FBUT, CED, CjED, and Schirmer 1 test (P , 0.002). LWE grade was found to be described as 20.001 + (0.283 • SG) 2 (0.253 • FBUT) + (0.003 • upper eyelid closing-phase maximum velocity) (R 2 = 0.57, P , 0.0001). The prevalence and grade of LWE were significantly higher in aqueous deficient dry eye.Conclusions: Tear volume, tear film stability, and blink should be considered as factors for determining LWE severity.

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