To better understand lid wiper epitheliopathy (LWE) from a cytological perspective, researchers conducted a study exploring the relationship between lid margin cell morphology, LWE, contact lens wear and lens-related symptoms. Rigid contact lens wear was associated with significantly wider, more keratinized lid wiper conjunctival regions, as determined by histology. Rigid lens wear was also associated with higher LWE grades compared with soft contact lens and non–lens wearers. The researchers believe these findings suggest a mechanical, lens-associated insult occurs at the lid margin, possibly linked to lens-related factors such as lens size, movement, material, edge design and modulus.

The study enrolled 20 habitual, symptomatic and 20 asymptomatic soft contact lens wearers, 18 rigid gas permeable wearers and 19 non–contact lens wearers. Participants were required to have a minimum of two years of continuous wear and a minimum wear schedule of three days per week. The upper lid wiper conjunctiva measured 424±171µm, 404±75µm, 667±219µm and 266±64µm in asymptomatic soft, symptomatic soft, rigid and non–contact lens wearers, respectively. The corresponding lower lid wiper conjunctivae measured 141±57µm, 232±150µm, 519±212µm and 225±102µm, which was significantly narrower than that of the upper eyelid in most cases.

The participants’ symptoms were not associated with any changes to the lid margin. Despite featuring prominent lid margin change, rigid lens wearers reported similar or better comfort than asymptomatic or even non-lens wearers. The researchers speculate that the apparent lack of correlation between friction-related insult and symptoms in rigid lens wearers might be masked by such mechanisms, thus preventing prediction of any association. Nevertheless, they note impression cytology offers a comprehensive view of the lid margin cytomorphology, allowing them to observe the effects of mechanical insult and to quantify the extent of vital staining LWE grades.

Muntz A, Subbaraman LN, Craig JP, Jones L. Cytomorphological assessment of the lid margin in relation to symptoms, contact lens wear and lid wiper epitheliopathy. Ocul Surf. December 7, 2019. [Epub ahead of print].