Atypical manifestation of upper lid margin staining in silicone hydrogel lens wearers with symptoms of dry eye

PURPOSE: To report an atypical manifestation of upper lid margin staining (ULMS) that occurred in adapted silicone hydrogel (SH) contact lens wearers who complained of ocular surface dryness. METHODS: Sequential staining with sodium fluorescein (FL) and lissamine green (LG) strips was performed in 38 SH lens wearers. The "wiper area" of the upper lid was examined with the slit lamp, at 8x and 12x magnifications. RESULTS: Four out of 38 subjects (10.5%) showed fimbriated or "feathery" extensions from the superior margin of the subtarsal fold onto the upper tarsal plate. The extent of these feathery extensions varied between subjects, with a mean (+/-S.D.) length of 2+/-0.8 mm. In all cases a broad band of staining with both FL and LG was demonstrated, which extended along the entire length of the lid margin. CONCLUSION: 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.