Objective To study the lid wiper area in vivo and in real time with confocal microscope， to understand the anatomy and histology of the region， and to provide the basis for further clinical diagnosis and treatment of lid-wiper epitheliopathy （LWE） and early dry eye. Methods Cases series study. Five volunteers without LWE and 15 patients with moderate to severe LWE were enrolled in the study at Beijing Jishuitan Hospital between September 2013 and March 2014. The lid wiper area was observed by confocal microscope， and the images were collected and analyzed. Results The lid wiper epithelium had a conjunctival structure of cuboidal cells which were different from the stratified squamous epithelium of the free lid margin. There was a clear dividing line in the meibomian gland′s openings. The lid wiper epithelium contained white cells and goblet cells. Compared to the volunteers without LWE， more holes and cracks were observed in the lid wiper epithelium in patients with moderate to severe LWE. Conclusion The anatomy， histology and pathological changes in the lid wiper area can be observed noninvasively， clearly and in real time with confocal microscope in vivo. The result can help us understand the mechanism of LWE， and provide the basis for further clinical diagnosis and treatment of LWE and early dry eye.