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

Jungah Huh; In Ho Woo; Youngsub Eom; Su-Yeon Kang; Hyo Myung Kim; Jong-Suk Song

doi:10.3341/jkos.2018.59.8.718

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Huh, Woo, Eom, Kang, Kim, and Song: Lid Wiper Epitheliopathy in Patients with Dry Eye Refractory to Conventional Medical Treatment

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(8): 718-723.

Published online: 14 August 2018

DOI: https://doi.org/10.3341/jkos.2018.59.8.718

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

Jungah Huh, MD, In Ho Woo, MD, Youngsub Eom, MD, PhD, Su-Yeon Kang, MD, PhD, Hyo Myung Kim, MD, PhD, Jong-Suk Song, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Address reprint requests to Jong-Suk Song, MD, PhD. Department of Ophthalmology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. Tel: 82-2-2626-1261, Fax: 82-2-857-8580, crisim123@korea.ac.kr

Received 8 March 2018 Revised 17 May 2018 Accepted 20 July 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Correlation, Dry eye, Lid wiper epitheliopathy, Medical, Refractory

Figures and Tables

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).

Table 1

Clinical characteristics of participants

Values are presented as mean ± standard deviation (range).

OSDI = Ocular Surface Disease Index; NEI = National Eye Institute.

^*By Korb protocol B, 2010.

Table 2

Multivariable analysis of factors associated with OSDI scores

OSDI = Ocular Surface Disease Index; Std. = standard; NEI = National Eye Institute.

^*By Korb protocol B, 2010; ^†p < 0.05; ^‡Multivariable analysis.

Notes

This study was supported in part by Alumni of Department of Ophthalmology, Korea University College of Medicine.

This study was presented as a narration at the 118th Annual Meeting of the Korean Ophthalmological Society 2017.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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