Bridging the gap: A new perspective on lid wiper epitheliopathy and meibomian gland inversion.

Lid wiper epitheliopathy (LWE) and meibomian gland inversion (MGI) are increasingly recognised causes of ocular surface discomfort and lid margin disease, yet their relationship remains poorly understood. This review examines the clinical, mechanistic, and histopathological evidence linking these conditions and evaluates whether they represent distinct entities or overlapping manifestations of a common disease process. A comprehensive literature search was conducted using PubMed, Embase, Scopus, Web of Science, the Cochrane Library, National Institutes of Health resources, and Google Scholar, supplemented by reference list screening and conference abstract review. The available evidence was analysed with emphasis on recent publications. Both LWE and MGI are characterised by symptoms that may be disproportionate to observable ocular surface findings and involve pathological changes localised to the upper eyelid margin. Shared features include associations with tear film instability, inflammation, mechanical forces generated during blinking, and alterations in the position of the mucocutaneous junction. However, important differences exist in their clinical presentation, diagnostic evaluation, histopathological characterisation, and the strength of supporting evidence. Current data suggest substantial overlap between the two conditions while remaining insufficient to establish whether they represent different stages or phenotypes of a single disease spectrum. An integrated conceptual framework may facilitate earlier recognition, improve diagnostic accuracy, and inform future research into eyelid margin disorders.