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Posters | Archive
August 2007


Atypical Upper Lid Margin Staining in SiH Wearers with Dry Eye Symptoms

Srinivasan, Sruthi, Jalaiah Varikooty, Lakshman N. Subbaraman, Anson Chan, Craig A. Woods, Trefford L Simpson, Lyndon W. Jones, Desmond Fonn


Purpose: To report an atypical manifestation of upper lid margin staining (ULMS) that occurs in adapted silicone hydrogel (SH) contact lens wearers who complain of ocular surface dryness

Methods: Atypical ULMS, using fluorescein (FL) and lissamine green (LG) strips (FL- Ful-Glo, Akorn Inc. 0.6 mg strips; LG - Rose Stone Enterprises, CA.1.5 mg strips) was observed in 4 out of 38 SH lens wearers. The area of the ULMS was examined with a slitlamp using 8 X and12X magnifications. ULMS was examined from the nasal location of the punctum to the temporal canthus in the upper lid. Subjects completed 5 clinical visits over a 4 week period. Digital images were obtained with both stains at all visits

Results: The general appearance of each subject’s ULMS corresponded to a stained area (with both Fl and LG) along the region of the upper lid margin extending from the area posterior to the meibomian gland orifices to the subtarsal fold. In addition, at most of the visits, each subject showed fimbriated extensions from the superior margin of the subtarsal fold onto the upper tarsal plate when the lid was everted. The extent of these feathery extensions varied between subjects with a mean (±SD) length of 2 mm±0.8. In addition, the angle made by these extensions with Marx’s line on the upper lid margin varied between subjects, ranging from approximately 90 degrees to being much more acute

Conclusions: The staining patterns shown on the subjects’ upper lid margins and tarsal plates suggest that ULMS may include more complex variants. The putative tissue damage revealed through the staining, points to a mechanism not simply restricted to the upper lid margin. Whether this is because of direct mechanical effect of the lid-lens interactions or more complex tissue-lens interactions remains to be investigated

Additional Comments: Sponsor: Johnson & Johnson Vision Care

Key Words: Contact Lenses - complications

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