Dry eye disease (DED) is one of the most common conditions seen in optometric practice, so it is essential to stay abreast of new diagnostic tools and the latest thinking. Recently, experts have emphasised the value of testing for lid wiper epitheliopathy (LWE) – a relatively new clinical sign linked to DED.

First described in 2002, LWE is an inflammatory eyelid change often caused by increased friction between the lid wiper region and the ocular surface (St Clair and Stokkermans, 2023; Korb et al, 2002). It is frequently associated with DED and poor contact lens (CL) hygiene and is now considered a useful diagnostic marker. 

DED affects up to 50% of people worldwide, and a third of UK adults (Vidal-Rohr et al, 2023; NICE, 2023). It causes discomfort, visual disturbance and tear film instability, potentially damaging the ocular surface (Vehof et al, 2014). 

LWE has been recognised as a key diagnostic sign since its inclusion in the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop DEWS diagnostic framework in 2017, reaffirmed in the latest TFOS DEWS III guidance (Wolffsohn et al, 2025).

A 2025 Chinese study proposed that both upper and lower LWE could serve as diagnostic criteria for DED and that LWE may be a more sensitive early indicator than fluorescein tear break-up time (Gao et al, 2025).