Lid wiper epitheliopathy is a frequent finding when symptoms of dry eye are experienced in the absence of routine clinical findings, possibly explaining why patients symptoms and objective clinical findings dont always correlate.

These findings by Donald R. Korb, O.D., and colleagues, were published in the January 2005 issue of Eye and Contact Lens.¹

The lid wiper is the portion of the marginal conjunctiva of the upper eyelid that wipes the ocular surface during blinking.

The researchers sought to investigate whether lid wiper epitheliopathy (LWE) occurred with patients who reported dry eye symptoms, yet had normal fluorescein break-up time, normal Schirmer test values and an absence of fluorescein staining.

The researchers divided 100 patients into two groups based on the presence or absence of dry eye symptoms. They instilled fluorescein and rose bengal dyes, then graded the lid wipers for staining from grade 0 (absent) to grade 3 (severe).

Seventy-six percent of patients had staining of the lid wiper vs. 12% of the asymptomatic patients.

In an earlier paper published in CLAO Journal in 2002, Dr. Korb and colleagues also found that 80% of symptomatic contact lens patients had lid wiper epitheliopathy vs. 13% of asymptomatic patients.²

Korb and co-workers have once again contributed in a significant way to the body of information available on ocular surface disease, says optometrist Joseph P. Shovlin, of Scranton, Pa. Specifically, they have provided a useful test to help guide clinical assessment in patients who present with dry eye symptoms yet have a paucity or absence of routine clinical findings.

However, optometrist Alan G. Kabat, of Nova Southeastern University College of Optometry, questions exactly how this condition relates to symptomology. Korb does not describe any theory by which lid wiper epithliopathy is associated with the sensation of ocular dryness, burning, etc., Dr. Kabat says. He does not discuss innervation of the tissue in any great degree, merely that the epitheliopathy is an associated finding with a high degree of correlation. So, I am left to ponder why the correlation exists.

Furthermore, the study did not include patients with corneal compromise.

Nonetheless, Dr. Kabat says, this high correlation between symptomology and LWE is significant and must be taken seriously.

In Other Dry Eye-Related News: Inspire Pharmaceuticals reports that the phase III study of diquafasol failed to show statistically significant improvement when compared with a placebo in the incidence of corneal clearing.   The company says the drug reached a number of secondary goals in the 640-patient trial, leaving hope that it may eventually be improved. The company plans to file an amendment to its original marketing application with the FDA for diquafasol by the end of the second quarter of 2005. Novartis has in-licensed rebamipide, an investigational treatment for dry eye, from Otsuka Pharmaceutical Company Ltd. Currently being tested in two Phase III studies in the United States, rebamipide is expected to demonstrate a novel mechanism of action to enhance tear secretion and increase the levels of mucin covering the conjunctiva and cornea of the eye. Under the agreement, Novartis will obtain an exclusive license with the right to sublicense the compound globally, excluding Japan and selected Asian countries, and will pay an upfront fee and royalties. Iodide iontophoresis has been demonstrated to be a safe and well tolerated method of improving subjective and objective dry eye factors in patients with ocular surface disease, according to a study in the British Journal of Ophthalmology. Researchers treated 16 patients with iodide iontophoresis (with current) and 12 patients with iodide application without current for 10 days. Both groups experienced a reduction of subjective symptoms, frequency of artificial tear application and an improvement in certain tear film and ocular surface factors. A stronger positive influence was seen in the iontophoresis group, as observed by improvement in break-up time, fluorescein and rose bengal staining and in a longer duration of this effect compared with patients in the non-current group. No significant change in Schirmer test results and impression cytology were observed in either group. Horwath-Winter J, Schmut O, Haller-Schober EM, Gruber A, Rieger G. Iodide iontophoresis as a treatment for dry eye syndrome. Br J Ophthalmol 2005 Jan;89(1):40-4.