Clinicopathologic Study of Conjunctivochalasis

Incidence of Non-Traumatic Subconjunctival Hemorrhage in an Indian Rural Population

Purpose

To determine the incidence of non-traumatic subconjunctival hemorrhage (NTSH) in Indian rural population and analyze the associated risk factors.

Methods

The study included patients diagnosed having subconjunctival hemorrhage (SCH) who attended the out-patient department (OPD) of ophthalmology. Demographic characteristics of subjects included age, gender, medical and ocular history, and location of hemorrhage.

Results

The incidence rate of NTSH in this study was 3.07 per 1000 patients per year attending OPD. The men to women ratio for NTSH was 1.26 (95% CI). The commonest site of presentation was nasal side (n=36, 51.4%). Right eye (n= 37, 54.3%) was affected more than the left eye (n=28, 40%). The analysis showed 24 patients (34.3%) did not have any etiological factor attributable to SCH. Conjunctivochalasis (CCH) was associated in 15 patients (21.4%). An antiplatelet agent was associated with SCH in 7 patients (10%). Other factors associated with SCH were hypertension, leukemia, and anemia (n=6, 8.6%).

Conclusion

This study indicates that NTSH occurs in 3 out of 1000 individuals per year in the rural population presenting to the OPD. Nasal conjunctiva was commonly involved. CCH was associated with 15 patients. Use of antiplatelet agents, hypertension and blood disorders are associated with the risk of NTSH. Patients presenting for the first time with NTSH should be screened for systemic etiological factors.

Conjunctivochalasis: a systematic review

Conjunctivochalasis (CCH) is a conjunctival condition characterized by loose, redundant conjunctival folds, most typically in the inferior bulbar conjunctiva of both eyes. Although CCH is a common cause of ocular irritation and discomfort, especially in the elderly, it is often overlooked in clinical practice. CCH may be associated with various ocular and nonocular conditions; however, the most important risk factor is aging. Although often asymptomatic, CCH may cause symptoms related to tear film instability and/or delayed tear clearance. Pathogenesis of CCH remains largely unknown but may involve different elements such as aged conjunctiva, unstable tear film, mechanical friction, ocular surface inflammation, and delayed tear clearance. Contradictory results have been reported on histopathologic changes in CCH, with some studies showing a normal microscopic structure. For symptomatic CCH, medical treatment may include lubrication and anti-inflammatory medications. For symptomatic patients who fail to respond to medical treatment, a surgical procedure may be considered. Although various surgical procedures have been used for CCH, more often, it consists of conjunctival cauterization or excision of the redundant conjunctiva, with or without amniotic membrane transplantation.

Histopathology of Conjunctivochalasis Compared to Normal Conjunctiva

Purpose:

To evaluate the histopathologic changes in the conjunctiva of patients with conjunctivochalasis (CCh) compared to age-matched controls.

Methods:

This cross-sectional, controlled study included 27 eyes of 27 patients with CCh and 16 eyes of 16 age-matched controls. A biopsy of the bulbar conjunctiva was performed along the temporal lower lid margin before cataract surgery in both groups. Histopathologic evaluation of the specimens was done with light microscopy using staining with hematoxylin/eosin, periodic acid Schiff, and van Gieson elastic stain. Various histopathologic features of the conjunctival epithelium and stroma were compared between the two groups.

Results:

The mean age of patients was 62.4 ± 6.9 years in the CCh group and 65.1 ± 6.3 years in the control group (P = 0.54). No significant differences were noted between the two groups in terms of conjunctival epithelial changes including papillomatosis, epithelial clefts, epithelial goblet cells, or infiltration of inflammatory cells. Mean thickness of the conjunctival stroma was 0.21 ± 0.08 mm in the CCh group and 0.26 ± 0.21 mm in the control group (P = 0.10). For the conjunctival stroma, there were no significant differences between the two groups in terms of elastosis, fibrosis, lymphangiectasia, or infiltration of inflammatory cells.

Conclusion:

No noticeable differences were found in the histopathologic features by light microscopy between eyes with CCh and those of age-matched controls. Therefore, the primary pathology of CCh may not be within the conjunctiva itself. Instead, loose attachment of the conjunctiva to the underlying tissue may be the reason for the redundant folds in the bulbar conjunctiva.

Assessing the severity of conjunctivochalasis in a senile population: a community-based epidemiology study in Shanghai, China

Background

In a previous hospital-based study, conjunctivochalasis was diagnosed in 85.24% of 1416 patients aged 1 to 94 years and in 98.5% of patients aged 60 or older. This report is the first to present data from a large scale epidemiologic study on conjunctivochalasis in a community-based population, thereby helping to better identify the severity of conjunctivochalasis in the general population.

Methods

This community-based epidemiologic study was conducted to evaluate prevalence rates and related factors of conjunctivochalasis among people over 60 years old in the CaoYangXinCun community, Shanghai, China. Cluster sampling was used in randomly selected local residents aged no less than 60 years. A cross-sectional study using a slit-lamp ophthalmoscope for examination was carried out from September 2008 to October 2008. A modified grading system based on the well-accepted Meller and Tseng's system was used. SPSS10.0 software was used for data and statistical analysis.

Results

A total of 2110 residents took part in this study, with a response rate of 94.85%. Among these, 930 cases were confirmed as conjunctivochalasis, with a prevalence rate of 44.08%. The prevalence rate increased with age (X² = 10.44, P < 0.01). A total of 1762 eyes were confirmed as conjunctivochalasis eyes. Of these eyes, 943 were classified as Grade I (53.52%), 647 as Grade II (36.72%), 162 as Grade III (9.19%), and the remaining 10 eyes as Grade IV (0.57%). The conjunctiva usually accumulated on the nasal and temporal areas of the conjunctival sac (944 eyes, 53.58%).

Conclusions

Although the rate estimated in the present study is not as high as reported in the former hospital-based study, conjunctivochalasis is considered a common age-related eye disease, deserving more attention to its early diagnosis.

Delayed Tear Clearance in Patients With Conjunctivochalasis Is Associated With Punctal Occlusion

PURPOSE

To evaluate the impact of punctal occlusion on ocular tear clearance and occurrence of epiphora in patients with conjunctivochalasis (CCh).

METHODS

Seventy-five eyes with the diagnosis of CCh were included in the study. CCh was graded on the basis of the extent of inferior lid margin involvement as follows: 1 = one location, 2 = 2 locations, and 3 = whole lid. Patients within the 3 groups were also subdivided on the basis of the presence of punctal occlusion. The presence of epiphora, occlusion of the inferior punctum, and fluorescein clearance test (FCT) results were recorded for every patient.

RESULTS

Of the 75 patients, 56 (75%) had epiphora, 47 (63%) had punctal occlusion, and 54 (72%) had delayed FCT. Twenty-two patients had grade 1 CCh, 43 had grade 2 CCh, and 10 had grade 3 CCh. Epiphora was present in 10 (45%) patients with grade 1 CCh, 38 (88%) patients with grade 2 CCh, and 8 (80%) patients with grade 3 CCh. Punctal occlusion and epiphora were observed more frequently in patients with grades 2 and 3 CCh compared with those with grade 1 CCh (Pearson chi test, P < 0.001). There was a strong correlation between delayed FCT and punctal occlusion (Spearman rank correlation analysis, r = 0.808, P < 0.001). Punctal occlusion was also correlated with the presence of epiphora (Spearman rank correlation analysis, r = 0.691, P < 0.001).

CONCLUSIONS

A significant proportion of patients with CCh are symptomatic beginning with early stages of CCh. There seem to be no significant differences in any of the clinical parameters between patients with grade 2 and grade 3 CCh. Punctal occlusion seems to play an important role in the impairment of ocular tear clearance and the occurrence of epiphora.