Lid wiper epitheliopathy: Current knowledge and future directions

Abstract

Abstract Lid wiper epitheliopathy (LWE) is a recently recognized clinical entity that involves the epithelial cells lining the lid wiper region of the upper and lower eyelids. LWE has gained attention in the field of ophthalmology due to its association with ocular discomfort, especially in contact lens wearers and individuals with dry eye symptoms. This review article aims to provide an overview of the current understanding of LWE, including its etiology, clinical implications, diagnosis, and potential treatment approaches. The etiology of LWE is believed to be multifactorial, with mechanical factors, contact lens wear, dry eye disease, and inflammation among the contributing factors. Clinically, LWE is diagnosed through the observation of the lid wiper region after staining with vital dyes. LWE is now recognized as a potential diagnostic sign of dry eyes, even in non-contact lens users. The condition has been linked to ocular surface discomfort and may explain a subset of dry eye cases where signs and symptoms do not correlate. Various grading scales have been used to assess the severity of LWE, with some studies exploring the potential of objective methods to complement subjective grading. While much progress has been made in understanding LWE, future research should focus on refining diagnostic criteria, exploring innovative treatment modalities, and investigating its association with other ocular surface conditions. A better understanding of LWE will contribute to improved management strategies and patient outcomes, particularly in individuals experiencing ocular discomfort and dry eye symptoms.