Cytomorphological assessment of the lid margin in relation to symptoms, contact lens wear and lid wiper epitheliopathy

• Published in: The ocular surface 2020-04, Vol.18 (2), p.214-220
• Main Authors: Muntz, Alex, Subbaraman, Lakshman N., Craig, Jennifer P., Jones, Lyndon
• Format: Article
• Language: English
• Subjects: Conjunctiva; Contact lens; Contact Lenses; Discomfort; Dry eye; Eyelids; Impression cytology; Keratinization; Lid wiper epitheliopathy; Marx line; Mucocutaneous junction; Surveys and Questionnaires
• ISSN: 1542-0124; 1937-5913
• DOI: 10.1016/j.jtos.2019.12.001

Purpose: Lid wiper epitheliopathy (LWE) is insufficiently understood from a cytological perspective. This study explored the relationship between lid margin cytomorphology, LWE, contact lens wear, and lens-related symptoms. Methods: Habitual, symptomatic (n = 20) and asymptomatic (n = 20) soft, rigid gas permeable (n = 18) and non-contact lens wearers (n = 19) were enrolled. LWE was graded using lissamine green and the Korb scale. Subjective symptoms were assessed using the Ocular Surface Disease Index and the Contact Lens Dryness Evaluation Questionnaire. Impression cytology samples obtained from the central upper and lower lid margins of both eyes stained histologically to highlight keratinization and imaged using high-resolution microscopy. A masked investigator digitally delimited and measured the average sagittal width of the lid wiper conjunctiva and mucocutaneous junction using ImageJ. Results: The upper lid wiper conjunctiva measured 424 ± 171 μm, 404 ± 75, 667 ± 219 and 266 ± 64 in asymptomatic soft, symptomatic soft, rigid and non-contact lens wearers, respectively. The corresponding lower lid wiper conjunctivae measured 141 ± 57 μm, 232 ± 150, 519 ± 212 and 225 ± 102, which was significantly narrower than that of the upper eyelid in most cases (p