Thanks to resources, research, and effort invested into the contact lens industry, contact lenses are still widely recommended by eyecare professionals. Unfortunately, we still have a problem. Despite all of our progress, we find that the number of contact lens users is plateauing. In a study by Markoulli and Kolanu (2017) that evaluated this, they determined that after three years, 10% to 50% of contact lens users discontinued wear due to contact lens discomfort. The researchers also noted that dry eye was the most common symptom causing contact lens dropout (Markoulli and Kolanu, 2017).

If we admit that many of our challenges have to do with dry eye, addressing and combating symptoms that relate to that condition can go a long way in helping eyecare professionals combat contact lens dropout.

So what clinical findings can help us diagnose dry eye associated with contact lens use? Some common findings include superficial punctate keratitis, conjunctival staining, and meibomian gland dysfunction (MGD). In this article, I want to discuss a finding that is often overlooked: lid wiper epitheliopathy (LWE).

LWE Basics

When we blink, there is a wiping motion of the upper eyelid against the ocular surface. Evidence suggests that the tear film, the glycocalyx of the cornea, and the conjunctival mucus in a healthy eye maintain this smooth surface. However, this system can be aggravated by contact lenses because the tear film becomes more delicate due to the increased friction between the eyelids and the contact lens.

LWE is a clinical condition characterized by the vital staining of the upper and lower eyelid areas that rub against the globe or contact lens. LWE is known to cause other symptoms, but it is commonly associated with contact lens-associated dry eye due to friction, irritation, and reduced lubrication between the palpebral lid and the contact lens.

Vital (Dye) Information

Eyecare practitioners can use vital dyes (such as lissamine green) to evaluate the progression of LWE by assessing the lid wiper area. To perform this test, practitioners will need to instill a generous amount of lissamine green onto a patient’s eyes and wait several minutes for the lissamine to take effect. After two-to-three minutes, flip the upper lid to inspect the palpebral conjunctiva next to the lid margin. The LWE will appear as green staining from the lid margin to the palpebral conjunctiva. Providers can make the lissamine green staining more visible by applying a red filter with a slit lamp.

Vital dyes can help eyecare professionals spot abnormalities early on by assessing and measuring LWE. There are various grading scales used to help us quantify LWE.

One example is a 0-to-3 scale that evaluates the levels of LWE severity (Korb et al, 2005), 0 indicating none present and 3 indicating severe based on the extent of horizontal and vertical lid margin staining using lissamine green, rose bengal, or sodium fluorescein vital stains.

Test Early

LWE is an often overlooked condition that may be contributing to the amount of dry eye cases among contact lens users. Testing for LWE is a useful and necessary measurement to find irregularities early so that you can provide treatment to lens wearers before they quit. CLS

For references, please visit www.clspectrum.com/references and click on document #308.