Lid-wiper epitheliopathy in contact lens users and patients with dry eye

To evaluate lid-wiper epitheliopathy (LWE) in contact lens users and in patients with symptoms characteristic of dry eye but with normal dry-eye tests and to compare the results with those of controls.

One hundred fifty-five patients were enrolled in the study and were divided into three groups. The first group included 69 contact lens users, the second group included 46 patients with dry eye, and the third group included 40 controls. The contact lens users were also divided as symptomatic and asymptomatic according to the Standard Patient Evaluation of Eye Dryness questionnaire and Ocular Surface Disease Index. The patients were examined for LWE with three different dyes (fluorescein, rose bengal, and lissamine green). The results were compared using chi-square and T tests.

More LWEs were detected in the contact lens and dry-eye groups compared with controls. In the contact lens group, 67% of the symptomatic patients and 32% of the asymptomatic patients showed LWE. The difference was statistically significant (P = 0.001). No significant correlation was found between LWE and the dry-eye tests (fluorescein breakup time and Schirmer test).

LWE should be investigated in symptomatic contact lens users and in patients with symptoms characteristic of dry eye but with normal dry-eye tests. Lid wiper may traumatize the corneal epithelium and increase the sensitivity of the cornea. This could be the main cause of the symptoms in patients without any significant dry-eye test findings.