{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:19:21Z","timestamp":1792012761070,"version":"4.4.0"},"reference-count":60,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deakin University Postgraduate Research Scholarship (DUPRS)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Allergic rhinitis (hay fever) prevalence has increased in Australia. People with hay fever often experience many eye symptoms, especially itching. This study explores clinical correlations between tear IgE levels and ocular allergy signs in hay fever sufferers, focusing also on eyelid wiper friction damage from eye rubbing. In a cross-sectional study from November 2024 to January 2025, 16 individuals with self-reported hay fever and 17 healthy controls were recruited. Participants completed demographic and allergy-related questionnaires, including symptoms and quality of life assessments. Tear samples were analyzed for IgE and MMP-9 biomarkers. Ocular surface parameters-bulbar redness, palpebral roughness, and lid wiper epitheliopathy (LWE)-were graded. Corneal and conjunctival dendritic cells were also evaluated. Elevated tear IgE significantly correlated with self-reported hay fever, QUICK score, MiniRQLQ, eye rubbing frequency, and lower LWE grade. The hay fever group showed significantly higher LWE compared to healthy controls (p &lt; 0.001), indicating frictional eyelid damage. ROC analysis of tear IgE yielded an AUC of 0.893 (cut-off 0.03 IU\/mL; sensitivity 90%, specificity 85%). Tear IgE is a useful biomarker for ocular inflammation and may indicate friction-related eyelid damage in allergy sufferers. Incorporating LWE grading into clinical assessments of ocular allergy is recommended.<\/jats:p>","DOI":"10.3390\/ijms26189116","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T14:45:46Z","timestamp":1758206746000},"page":"9116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring the Diagnostic Utility of Tear IgE and Lid Wiper Epitheliopathy in Ocular Allergy Among Individuals with Hay Fever"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3472-3509","authenticated-orcid":false,"given":"Rinu","family":"Thomas","sequence":"first","affiliation":[{"name":"School of Medicine (Optometry), Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-4098","authenticated-orcid":false,"given":"Serap","family":"Azizoglu","sequence":"additional","affiliation":[{"name":"School of Medicine (Optometry), Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0101-0668","authenticated-orcid":false,"given":"Cenk","family":"Suphioglu","sequence":"additional","affiliation":[{"name":"NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Centre for Sustainable Bioproducts (CSB), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9036-8689","authenticated-orcid":false,"given":"Ereeny","family":"Mikhail","sequence":"additional","affiliation":[{"name":"School of Medicine (Optometry), Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5702-6736","authenticated-orcid":false,"given":"Moneisha","family":"Gokhale","sequence":"additional","affiliation":[{"name":"School of Medicine (Optometry), Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"},{"name":"Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","unstructured":"Health Conditions Prevalence (2024, July 19). 2022 | Australian Bureau of Statistics 2023, Available online: https:\/\/www.abs.gov.au\/statistics\/health\/health-conditions-and-risks\/health-conditions-prevalence\/latest-release."},{"key":"ref_2","unstructured":"Owen, A.J.A., Punt, J., and Stranford, S.A. (2018). Kuby Immunology, WH Freeman. [7th ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4274\/tjo.galenos.2020.11456","article-title":"Current Knowledge in Allergic Conjunctivitis","volume":"51","author":"Villegas","year":"2021","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"179326","DOI":"10.1016\/j.scitotenv.2025.179326","article-title":"Influence of ENSO, droughts, and temperature rise on pollen and pollen seasons in Australia","volume":"975","author":"Dhankhar","year":"2025","journal-title":"Sci. Total Environ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1111\/all.12009","article-title":"Ocular allergy: Recognizing and diagnosing hypersensitivity disorders of the ocular surface","volume":"67","author":"Leonardi","year":"2012","journal-title":"Allergy"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1159\/000093076","article-title":"The Differential Diagnosis of Red Eye: A Survey of Medical Practitioners from Eastern Europe and the Middle East","volume":"220","author":"Petricek","year":"2006","journal-title":"Ophthalmologica"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"P94","DOI":"10.1016\/j.ophtha.2018.10.020","article-title":"Conjunctivitis Preferred Practice Pattern\u00ae","volume":"126","author":"Varu","year":"2019","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.exer.2013.07.019","article-title":"Allergy and allergic mediators in tears","volume":"117","author":"Leonardi","year":"2013","journal-title":"Exp. Eye Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Aydin, E., Callahan, D.L., Chong, L., Azizoglu, S., Gokhale, M., and Suphioglu, C. (2024). The Plight of the Metabolite: Oxidative Stress and Tear Film Destabilisation Evident in Ocular Allergy Sufferers across Seasons in Victoria, Australia. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25074019"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/cxo.12038","article-title":"Effects of eye rubbing on the levels of protease, protease activity and cytokines in tears: Relevance in keratoconus","volume":"96","author":"Balasubramanian","year":"2013","journal-title":"Clin. Exp. Optom."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1097\/ICO.0000000000002116","article-title":"Pain, Dryness, and Itch Sensations in Eye Surface Disorders Are Defined by a Balance Between Inflammation and Sensory Nerve Injury","volume":"38","author":"Belmonte","year":"2019","journal-title":"Cornea"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jtos.2014.12.004","article-title":"Spontaneous Blinking from a Tribological Viewpoint","volume":"13","author":"Pult","year":"2015","journal-title":"Ocul. Surf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11249-023-01787-4","article-title":"Friction and Lubrication of Eye\/Lens\/Lid Interface: The Effect of Lubricant and Contact Lens Material","volume":"71","author":"Vrbka","year":"2023","journal-title":"Tribol. Lett."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1136\/bjo.84.8.834","article-title":"Atopy and keratoconus: A multivariate analysis","volume":"84","author":"Bawazeer","year":"2000","journal-title":"Br. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/ACI.0000000000000571","article-title":"Pathogenesis and complications of chronic eye rubbing in ocular allergy","volume":"19","author":"Erdinest","year":"2019","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/ICO.0000000000002150","article-title":"The Prevalence and Risk Factors for Keratoconus: A Systematic Review and Meta-Analysis","volume":"39","author":"Hashemi","year":"2020","journal-title":"Cornea"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"418","DOI":"10.3109\/09273948.2016.1145697","article-title":"Effect of Allergic Diseases on Keratoconus Severity","volume":"25","author":"Naderan","year":"2017","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.18240\/ijo.2019.11.17","article-title":"The correlation between keratoconus and eye rubbing: A review","volume":"12","author":"Najmi","year":"2019","journal-title":"Int. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40662-021-00241-7","article-title":"Corneal biomechanical changes in allergic conjunctivitis","volume":"8","author":"Wang","year":"2021","journal-title":"Eye Vis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/00003226-199705000-00013","article-title":"Histopathology of the Ocular Surface After Eye Rubbing","volume":"16","author":"Greiner","year":"1997","journal-title":"Cornea"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1097\/ICO.0b013e3181d3d660","article-title":"Epithelial Responses to Rubbing-Related Mechanical Forces","volume":"29","author":"McMonnies","year":"2010","journal-title":"Cornea"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Aydin, E., Dhar, P., Gokhale, M., Chong, L., Azizoglu, S., and Suphioglu, C. (2022). A Review of Emerging Tear Proteomics Research on the Ocular Surface in Ocular Allergy. Biology, 11.","DOI":"10.3390\/biology11020312"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e12139","DOI":"10.1002\/clt2.12139","article-title":"Total IgE in tears accurately reflects the severity and predicts the prognosis of seasonal allergic conjunctivitis","volume":"12","author":"Bao","year":"2022","journal-title":"Clin. Transl. Allergy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2332\/allergolint.09-OA-0101","article-title":"Clinical Evaluation of Total IgE in Tears of Patients with Allergic Conjunctivitis Disease Using a Novel Application of the Immunochromatography Method","volume":"58","author":"Inada","year":"2009","journal-title":"Allergol. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3203","DOI":"10.1167\/iovs.08-2476","article-title":"Production and Activity of Matrix Metalloproteinase-9 on the Ocular Surface Increase in Dysfunctional Tear Syndrome","volume":"50","author":"Chotikavanich","year":"2009","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1097\/ICL.0000000000000432","article-title":"Keratoconus Progression in Patients with Allergy and Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test","volume":"44","author":"Mazzotta","year":"2018","journal-title":"Eye Contact Lens Sci. Clin. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jtos.2015.10.004","article-title":"The Matrix Metalloproteinase 9 Point-of-Care Test in Dry Eye","volume":"14","author":"Lanza","year":"2016","journal-title":"Ocul. Surf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101600","DOI":"10.1016\/j.clae.2022.101600","article-title":"Effects of contact lens wear on tear inflammatory biomarkers","volume":"45","author":"Sampaio","year":"2022","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajo.2025.05.033","article-title":"TFOS DEWS III Diagnostic Methodology","volume":"279","author":"Wolffsohn","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.ajo.2007.06.028","article-title":"Development and testing of the quality of life in children with vernal keratoconjunctivitis questionnaire","volume":"144","author":"Sacchetti","year":"2007","journal-title":"Am. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Aydin, E., Nie, S., Serap Azizoglu Chong, L., Gokhale, M., and Suphioglu, C. (2024). What\u2019s the situation with ocular inflammation? A cross-seasonal investigation of proteomic changes in ocular allergy sufferers\u2019 tears in Victoria, Australia. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1386344"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/08164622.2025.2471385","article-title":"Ocular allergy and quality of life in a regional Australian optometry practice","volume":"24","author":"Christiansen","year":"2025","journal-title":"Clin. Exp. Optom."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/S0161-6420(87)33355-X","article-title":"Tear and serum IgE concentrations by Tandem-R IgE immunoradiometric assay in allergic patients","volume":"94","author":"Insler","year":"1987","journal-title":"Ophthalmology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/0091-6749(94)90349-2","article-title":"Assessment of quality of life in adolescents with allergic rhinoconjunctivitis: Development and testing of a questionnaire for clinical trials","volume":"93","author":"Juniper","year":"1994","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1755-3768.1985.tb05224.x","article-title":"Allergic conjunctivitis, total and specific IgE in the tear fluid","volume":"63","author":"Kari","year":"1985","journal-title":"Acta Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1080\/09273948.2019.1629462","article-title":"IgE Ratio in Tears: A Predictive Tool of Ocular Allergic Inflammation","volume":"28","author":"Neil","year":"2020","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1038\/eye.1998.68","article-title":"Tear IgE concentrations in allergic conjunctivitis","volume":"12","author":"Nomura","year":"1998","journal-title":"Eye"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/112067211002000201","article-title":"Allergic Conjunctivitis: A National Cross-Sectional Study of Clinical Characteristics and Quality of Life","volume":"20","author":"Palmares","year":"2010","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1111\/cea.12536","article-title":"Allergic conjunctivitis: A cross-sectional study","volume":"45","author":"Leonardi","year":"2015","journal-title":"Clin. Exp. Allergy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1111\/all.13178","article-title":"Diagnostic tools in ocular allergy","volume":"72","author":"Leonardi","year":"2017","journal-title":"Allergy"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/j.1444-0938.2003.tb03082.x","article-title":"Keratoconus, allergy, itch, eye-rubbing and hand-dominance","volume":"86","author":"McMonnies","year":"2003","journal-title":"Clin. Exp. Optom."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Shang, X., Zhang, Y., Luo, S., Liu, M., Li, H., Fang, X., Xie, Z., Xiao, X., Yang, Z., and Lin, Y. (2025). Tear IgE point-of-care testing for differentiating type I and type IV allergic conjunctivitis. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1577656"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_44","first-page":"37","article-title":"Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome","volume":"4","author":"Pflugfelder","year":"2017","journal-title":"Met. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s10792-019-01149-x","article-title":"Relationship between tear eotaxin-2 and MMP-9 with ocular allergy and corneal topography in keratoconus patients","volume":"40","author":"Mutlu","year":"2020","journal-title":"Int. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Marques, J.C., Ladislau De Carvalho, K.I., Xavier, R., Nos\u00e9, W., and Rizzo, L.V. (2023). Inflammatory profile of keratoconic corneal epithelium. BMC Ophthalmol., 23.","DOI":"10.1186\/s12886-023-03013-0"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1038\/s41385-020-0288-4","article-title":"IL-33\/ST2\/IL-9\/IL-9R signaling disrupts ocular surface barrier in allergic inflammation","volume":"13","author":"Hu","year":"2020","journal-title":"Mucosal Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Janiszewska-Bil, D., Grabarek, B.O., Lyssek-Boro\u0144, A., Kie\u0142basi\u0144ska, A., Kuraszewska, B., Wyl\u0119ga\u0142a, E., and Krysik, K. (2024). Comparative Analysis of Corneal Wound Healing: Differential Molecular Responses in Tears Following PRK, FS-LASIK, and SMILE Procedures. Biomedicines, 12.","DOI":"10.3390\/biomedicines12102289"},{"key":"ref_49","first-page":"199","article-title":"Wound healing of the corneal epithelium: A review","volume":"15","author":"Ghafar","year":"2021","journal-title":"Asian Biomed. Res. Rev. News"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.4103\/IJO.IJO_2709_22","article-title":"Lid wiper epitheliopathy in symptomatic and asymptomatic dry eye subjects","volume":"71","author":"Kamath","year":"2023","journal-title":"Indian J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1038\/eye.2010.228","article-title":"The relationship between clinical signs and dry eye symptoms","volume":"25","author":"Pult","year":"2011","journal-title":"Eye"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.clae.2006.12.002","article-title":"Incomplete blinking: Exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses","volume":"30","author":"McMonnies","year":"2007","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/ICL.0b013e3181d94e82","article-title":"Lid-Wiper Epitheliopathy in Contact Lens Users and Patients with Dry Eye","volume":"36","author":"Yeniad","year":"2010","journal-title":"Eye Contact Lens"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"AB162","DOI":"10.1016\/j.jaci.2024.12.513","article-title":"Ocular Allergy: The Importance of Identifying Sensitization, Clinical Profiles and Quality of Life","volume":"155","author":"Velazquez","year":"2025","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2945","DOI":"10.1016\/j.jaip.2020.04.023","article-title":"Questionnaires Assessing the Quality of Life of Ocular Allergy Patients","volume":"8","author":"Mikhail","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1046\/j.1365-2222.2000.00668.x","article-title":"Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire","volume":"30","author":"Juniper","year":"2000","journal-title":"Clin. Exp. Allergy"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/00006324-199303000-00011","article-title":"CCLRU standards for success of daily and extended wear contact lenses","volume":"70","author":"Terry","year":"1993","journal-title":"Optom. Vis. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"101773","DOI":"10.1016\/j.clae.2022.101773","article-title":"Development and validation of a new photographic scale to grade lid wiper epitheliopathy","volume":"46","author":"Lievens","year":"2023","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/09273948.2022.2155843","article-title":"Corneal Epithelial Dendritic Cells: An Objective Indicator for Ocular Surface Inflammation in Patients with Obstructive Meibomian Gland Dysfunction?","volume":"32","author":"Chen","year":"2024","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1167\/iovs.08-2722","article-title":"Conjunctival In Vivo Confocal Scanning Laser Microscopy in Patients with Sj\u00f6gren Syndrome","volume":"51","author":"Wakamatsu","year":"2010","journal-title":"Investig. Ophthalmol. Vis. Sci."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9116\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:09Z","timestamp":1760035689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/18\/9116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":60,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijms26189116"],"URL":"https:\/\/doi.org\/10.3390\/ijms26189116","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}