Lid wiper epitheliopathy in patients with dry eye refractory to conventional medical treatment

Purpose: We evaluated the effects of lid wiper epitheliopathy on the clinical manifestations of dry eye in patients refractory to conventional medical treatment. Methods: Forty-six patients (46 eyes) completed the subjective Ocular Surface Disease Index (OSDI), and we obtained objective measures including the tear break-up time (TBUT), the National Eye Institute (NEI) corneal staining score, tear osmolarity, and lid wiper epitheliopathy as revealed on photographs taken using a yellow filter after fluorescein instillation. The images were graded using the Korb B protocol. Results: The mean OSDI score was 48.06 ± 21.19; 34 patients (73.9%) were had scores ≥33. Lid wiper epitheliopathy was evident in 41 (89.1%), and the epitheliopathy grade and OSDI score were correlated (r = 0.56, p < 0.01). The NEI score was also positively correlated with the OSDI score (r = 0.54, p < 0.01), but the mean value was low (1.59 ± 2.13). The OSDI score did not correlate significantly with either the TBUT or tear osmolarity (r = -0.16, p = 0.279; r = 0.16, p = 0.298, respectively). Conclusions: Lid wiper epitheliopathy was present in about 90% of patients with dry eye who visited our tertiary hospital, and a significant correlation was evident between the epitheliopathy grade and the OSDI score.