Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
Johnson & Johnson Vision Care, Inc., 7500 Centurion Parkway, Jacksonville, FL 32256, USA.
Prog Retin Eye Res. 2016 Jul;53:140-174. doi: 10.1016/j.preteyeres.2016.04.004. Epub 2016 Apr 14.
Some recent research has resulted in a hypothesis that there is a common 'lid wiper' region that is apposite to the ocular surface or anterior lens surface (where contact lenses are worn), responsible for spreading tears during blinking. In the upper eyelid, it extends about 0.6 mm from the crest of the sharp posterior (inner) lid border (i.e. the mucocutaneous junction, or line of Marx) to the subtarsal fold superiorly and from the medial upper punctum to the lateral canthus horizontally. Histologically, it is seen as an epithelial elevation comprising of stratified epithelium with a transitional conjunctival structure of (moving posteriorly) squamous cells then cuboidal cells, with some parakeratinised cells and goblet cells. Lid wiper epitheliopathy (LWE) denotes staining of the lid wiper observed after instillation of dyes such as fluorescein, rose bengal or lissamine green. There have been some reports of higher rates of LWE in dry eye patients and contact lens wearers, but others have failed to find such associations. The primary cause of LWE is thought to be increased friction between the lid wiper and ocular or anterior contact lens surface due to inadequate lubrication, which could be caused by dry eye and may be exacerbated by factors such as abnormal blinking patterns, poor contact lens surface lubricity and adverse environmental influences. Recent evidence suggests that LWE is associated with sub-clinical inflammation. LWE has the potential to provide the missing mechanistic link between clinical observation and symptoms associated with dry eye and contact lens wear. Clinical and fundamental research into LWE is still in its infancy and in many instances equivocal; however, it is an idea that provides a potentially important new avenue for further investigation of anterior eye discomfort associated with ocular dryness and contact lens wear.
一些最近的研究产生了一个假设，即存在一个共同的“眼睑擦拭器”区域，与眼表面或前晶状体表面（隐形眼镜佩戴的位置）相对应，负责在眨眼时扩散眼泪。在上眼睑，它从锐利的后（内）眼睑边界的嵴（即黏膜皮肤交界处或 Marx 线）向上延伸约 0.6 毫米到上眼睑皱襞，从内侧上泪小点到外侧眦水平。组织学上，它被视为上皮隆起，由复层上皮组成，具有移行结膜结构的（向后移行）鳞状细胞，然后是立方细胞，还有一些角化细胞和杯状细胞。眼睑擦拭器上皮病（LWE）表示在滴注荧光素、孟加拉玫瑰红或丽丝胺绿等染料后观察到的眼睑擦拭器染色。有一些报告称，干眼症患者和隐形眼镜佩戴者的 LWE 发生率较高，但也有其他报告未能发现这种关联。LWE 的主要原因被认为是由于缺乏润滑，眼睑擦拭器和眼或前接触镜表面之间的摩擦力增加，这可能是由干眼症引起的，并且可能会因眨眼模式异常、隐形眼镜表面润滑不良和不利的环境影响等因素而加剧。最近的证据表明，LWE 与亚临床炎症有关。LWE 有可能为干眼症和隐形眼镜佩戴相关的临床观察和症状之间提供缺失的机械联系。对 LWE 的临床和基础研究仍处于起步阶段，在许多情况下存在争议；然而，它是一个提供了一个潜在的重要新途径，可以进一步研究与眼干燥和隐形眼镜佩戴相关的前眼部不适。
