Lid Wiper Epitheliopathy Correlated With Tear Volume, Tear Film Stability, and Blink

Dry Eye
Effective lid wiper epitheliopathy treatment involves improving tear volume and tear film stability, a study suggests.

Lid wiper epitheliopathy (LWE) severity may be determined by tear volume, tear film stability, and blink in patients with dry eye, according to a study published in Cornea.  

Researchers conducted a study of 76 eyes of 76 women with dry eyes (mean age 57.2±16.0 years). They evaluated tear meniscus radius, tear film lipid layer spread grade (SG), fluorescein breakup time (FBUT), fluorescein breakup pattern, corneal and bulbar conjunctival epithelial damage (CED), upper eyelid LWE grade and performed Schirmer 1 test on participants. The team also measured blink rate, palpebral aperture height, upper eyelid opening/closing-phase amplitude and duration, and maximum velocity.  

The researchers found significant correlations between LWE grade and tear meniscus radius, SG, FBUT, CED, CjED, and Schirmer 1 test (P <.002). They determined that LWE grade could be calculated as −0.001 + (0.283 × SG) – (0.253 × FBUT) + (0.003 × upper eyelid closing-phase maximum velocity) (R2 =0.57, P <.0001). According to the report, the prevalence and severity of LWE (52.9% and 0.88±0.98, respectively) were significantly higher in patients diagnosed with aqueous deficient dry eye

Based on the association between LWE and tear parameters, the researchers state, “LWE can be treated by improving tear volume and tear film stability by using eye drops or punctal occlusion in the clinical setting because the velocity of the upper eyelid during blinking cannot be changed.” 

Study limitations include a single center design, the exclusion of men with dry eyes, failure to consider lubrication type, and failure to use noninvasive methods for measuring tear film breakup time.  

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Kato H, Yokoi N, Watanabe A, et al. Clinical factors for determining the severity of lid wiper epitheliopathy in dry eye. Cornea. 2022;41(5):539-544. doi:10.1097/ICO.0000000000002879