Staining characteristics of the lid margin

Background Vital stains are very important for evaluation of Marx line (ML) location, regularity, and lid wiper epitheliopathy. ML score can be used to assess Meibomian gland function, whereas lid wiper epitheliopathy is considered an early indicator for tear film instability. Aim To evaluate staining characteristics of the lid margin in different disease conditions, such as dry eye, Meibomian gland dysfunction (MGD), and eyelid malposition using vital stains. Patients and methods A total of 80 patients aged between 40 and 60 years were included in this study. Patients were already diagnosed as having dry eye, MGD, and eyelid malposition (ectropion and entropion). Vital stains (fluorescein, rose Bengal, and Lissamine green) were used to assess the lid wiper area and ML position in these diseases. Results The included 80 participants comprised 44 females and 36 males aged from 40 to 60 years, with mean±SD of 45.10 ± 5.42 years for normal participants, and it was 47.35 ± 6.57 years for dry eye participants. ML was straight in 75% of normal group, but it was irregular in 65% of the dry eye group, 100% of the malposition group, and 70% of MGD group. Lid wiper epitheliopathy was mild degree in one-third of normal participants. In dry eye participants, it was moderate and severe (45% for each). Conclusion ML is irregular and moved gradually anterior to the eyelid margin with different diseases such as dry eye, MGD, and eyelid malposition. Lid wiper epitheliopathy provides information about the location of ML, and it can be easily seen by using the vital staining, and it is useful in the diagnosis of tear film instability.