From Itch to Injury: An Emerging Link Between Allergic Conjunctivitis, Eye Rubbing and Lid Wiper Epitheliopathy

Allergic conjunctivitis (AC) is a common inflammatory ocular surface disease characterised by ocular itch, conjunctival redness, tearing, and frequent eye rubbing. Although the link between AC, eye rubbing and development of keratoconus is well established, the relationship between AC and lid wiper epitheliopathy (LWE) is less understood. Recent studies have identified a potential association between AC and LWE, suggesting that friction-induced damage to the lid wiper region may represent an under-recognised consequence of allergic conjunctivitis. This review synthesises current evidence linking allergic conjunctivitis, eye rubbing, ocular surface friction, and LWE, while highlighting emerging mechanistic insights from multi-omics research. LWE has potential as a novel clinical indicator of AC and may provide additional diagnostic value alongside other established biomarkers.