Purpose:

To document the severity of lid wiper epitheliopathy (LWE) by Lissamine green (LG) vital staining in distinct regions of the upper and lower eyelid margins [temporal, central, nasal, and far nasal regions (FNR)] as a function of the degree of meibomian gland dysfunction (MGD).

Methods:

This observational study examined the eyelid margins of symptomatic dry eye patients (DEP) defined by SPEED score ≥6 and meibomian gland assessment (MGA) score ≤30. DEP were divided into two groups based on meibomian gland dysfunction (MGD) as measured by MGA scores- moderate to severe (M-S) MGD (MGA ≤12, n=57 eyes) and mild to moderate (M-M) MGD (MGA >12-30, n=103 eyes). The degree of LWE as detected by LG vital staining was assessed for 4 distinct regions of the eyelid margin: temporal (T), central (C), nasal (N)and far nasal region (FNR), the latter being the area between the punctum and the nasal canthus. The area of staining was graded on a scale of 0-3). Additionally, composite scores [(T+C+N)/3] were generated for purposes of comparing the lid margin regions directly over the tarsal plate to the FNR.

Results:

Both M-M and M-S groups had less LWE staining in the central regions of the LL than the respective nasal or temporal regions (p<0.001). there="" was="" no="" corresponding="" regional="" difference="" in="" the="" ul.="" fnr="" vs="" n,="" fnr="" vs="" c,="" fnr="" vs="" t="" was="" significantly="" greater="" than="" the="" average="" of="" the="" lid="" regions="" in="" both="" groups="" and="" in="" both="" ul="" and="" ll=""><0.001). the="" composite="" score="" in="" the="" m-m="" group="" was="" greater="" the="" ll="" than="" the="" ul=""><0.05); no="" such="" difference="" was="" found="" with="" the="" m-s="" group.="" both="" groups="" however,="" had="" greater="" staining="" in="" the="" fnr="" vs.="" the="" composite="" score=""><0.001). there="" was="" increased="" staining="" of="" the="" fnr="" in="" the="" ll="" compared="" to="" the="" fnr="" in="" the="" ul="" in="" both="" groups=""><0.01).>

Conclusions:

MGD, as defined by MGA scores, is not a reliable predictor of the degree of LWE. FNR staining appears to be a general feature of MGD-associated dry eye in the present study. Interestingly, the degree of MGD was inversely related to the LWE staining composite score in the lower eyelid.