Transcript Epitheliopathy in the Region of the Eyelid Associated With the

Epitheliopathy in the Region of the
Eyelid Associated with the Caruncle in
Normal Subjects and Dry-Eye Patients
Jack V. Greiner, M.S., D.O., Ph.D.
Paula J. Oliver, A.S., Rina Wu,
Mikhail Salganik, Ph.D.
The Schepens Eye Research Institute
Massachusetts Eye and Ear Infirmary
Harvard Medical School
The Boston Ocular Surface Center
None of the authors have any financial interest to disclose
Purpose
To employ vital staining to describe the presence
of lid margin epitheliopathy (LME) in the region of
the upper and lower eyelids associated with the
caruncle and plica semilunaris in normal subjects
and dry eye patients.
Methods
In this prospective study, 100 patients (200 eyes)
with evaporative dry eye disease (meibomian gland
dysfunction) and 100 normal subjects (200 eyes)
were examined.
Patients with dry eye disease were defined with a
validated Standard Patient Evaluation for Eye
Dryness (SPEED) questionnaire score of ≥6 and
meibomian gland secretion (MGS) score of ≤20.
Methods
For the purposes of this study, the region of the
eyelid margin associated with the caruncle was
defined as that area of the upper and lower eyelid
margin medial to the puncta and extending to the
medial canthus.
Biomicroscopy
Biomicroscopy of upper and lower eyelid margins
from the puncta to the medial canthus was
performed at 25x and 40x magnification 90 sec
after instillation of Lissamine green vital stain into
the conjunctival sac.
Lissamine Green Staining
The degree of Lissamine green staining of the
lower lid margin between the punctum and the
medial canthus (arrows) was determined using the
following scale: 1( mild) [left figure], 2 (moderate)
[center figure], and 3 (severe) [right figure].
Lissamine Green Staining
The degree of Lissamine green staining of the
upper eyelid margin between the punctum and the
medial canthus (arrows) was determined using the
following scale: 1( mild) [left figure], 2 (moderate)
[center figure], and 3 (severe) [right figure].
Results
Essentially all normal subjects and dry eye patients
exhibited staining in this caruncular zone between
the puncta and the medial canthus, although the
degree of staining in the area of the lower lid
margin was significantly greater in patients with
dry eye disease (p<0.05).
Results
Interestingly there was a significant difference
between right and left eyes (p<0.5) in both normal
subjects and dry eye patients with the left eye
exhibiting a greater degree of staining than the
right eye.
The most significant difference between dry eye
patients and controls is that the degree of staining
in the lower eyelid margin associated with the
caruncular zone is more intense in dry eye patients
than controls (p<0.05).
Conclusions
In contrast to prior results documenting a lack of
correlation between vital staining in temporal
regions and dry eye symptoms,1 symptomatic dry
eye patients have more eyelid margin staining in
the caruncular region than normal subjects.
Vital staining of this clinically-overlooked region of
the eyelid margin (although anatomically
comprising >10% of the eyelid margin) may have
potential benefits as a marker and an additional
diagnostic tool that may be particularly
informative in those patients with a questionable
presentation of dry eye.
1Greiner
JV: Association of epitheliopathy of upper and lower eyelid
marginal conjunctiva with meibomian gland dysfunction and
symptoms of dry-eye disease. ASCRS, April 27, 2014.
Epitheliopathy in the Region of the
Eyelid Associated with the Caruncle in
Normal Subjects and Dry-Eye Patients
Jack V. Greiner, M.S., D.O., Ph.D.
Paula J. Oliver, A.S., Rina Wu
Mikhail Salganik, Ph.D.
The Schepens Eye Research Institute
Massachusetts Eye and Ear Infirmary
Harvard Medical School
The Boston Ocular Surface Center