Article

Clinic-Cytologic Study of Conjunctivochalasis and Its Relation to Thyroid Autoimmune Diseases

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

To determine the prevalence of conjunctivochalasis in patients with immune thyroid diseases, to determine whether there is any association between the 2 diseases, and to determine cytologic study of conjunctivochalasis through the cytology impression test. A clinical prospective cohort study carried out by the External Diseases Department in the Ophthalmology Sector and the Thyroid Department in the Endocrinology Sector at Federal University of Sao Paulo (UNIFESP). The patients included were divided into 2 groups following these inclusion criteria: a control group of 25 patients without thyroid diseases, confirmed after clinical and laboratory examinations (thyroid hormones), or any other ocular diseases. The study group consisted of 31 patients with thyroid diseases, the diagnosis of which was confirmed by the Endocrinology Sector. The thyroidopathies included were autoimmune diseases but excluded nonautoimmune diseases. A protocol endorsed by the UNIFESP was followed, using clinical and ophthalmological history, biomicroscopy, and impression cytology. Fifty-two percent of patients without thyroid diseases and 88% of patients with thyroid diseases presented with conjunctivochalasis. The risk ratio was 1.705 (Pr > chi(2) = 0.0038), indicating that there is an association between them. For the impression cytology in inferior bulbar conjunctiva, there was an association between the result of the impression cytology and conjunctivochalasis (Pearson chi(2) = 10.1190 Pr = 0.006). The prevalence of conjunctivochalasis in patients with autoimmune thyroid diseases was 88%. Patients with autoimmune thyroidopathy presented higher percentages of conjunctivochalasis than the control group, confirming the association between them. The cytologic study showed the highest prevalence of abnormal surface features in eyes with conjunctivochalasis.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Conjunctival samples were evaluated according to established techniques for the following parameters (7)(8)(9) : cellularity, cell-to-cell contact of epithelial cells, nucleus-to-cytoplasm (N:C) ratio, nuclear chromatin level, goblet cell density, keratinization, and distribution of inflammatory cells. A score of 0 to 3 was assigned to each of these features. ...
... Therefore, a grading system (IC score) that included several morphological parameters (IC subscores) was devised to provide a complete analysis of conjunctival alteration. The parameters were separately judged and totaled to yield the final score, as described elsewhere (8)(9) . ...
Article
Full-text available
To report the impression cytologic results after corneal cross-linking and insertion of intrastromal corneal ring segments for keratoconus. Thirty-nine eyes were distributed into two groups: 1) cross-linking group (patients underwent corneal cross-linking procedure), and 2) riboflavin eyedrops group (patients received 0.1% riboflavin (w/v) eyedrops in 20% dextran solution for 1 month). After 3 months, all patients underwent insertion of intrastromal corneal ring segments. Impression cytologic specimens were obtained from all eyes at baseline, at 1 month and 3 months after cross-linking or riboflavin eyedrops, and again at 6 months, 1 year, and 2 years after intrastromal corneal ring segment insertion. Patients in the cross-linking group demonstrated improvement in the cell-to-cell contact of epithelial cells and the nucleus-to-cytoplasm ratio on the temporal conjunctiva after treatment (P=0.008 and P=0.047), respectively. On the superior conjunctiva, increases in goblet cell density (P=0.037) and level of organization of nuclear chromatin (P=0.010) after treatment were noted. Patients in the riboflavin eyedrops group demonstrated improvement in the cell-to-cell contact of epithelial cells on the superior conjunctiva after treatment (P=0.021). On the temporal conjunctiva, an improvement in the cell-to-cell contact of epithelial cells (P<0.001) and increases in the nucleus-to-cytoplasm ratio (P<0.001), goblet cell density (P=0.001), and less keratinization (P=0.011) were noted. No changes were identified on the cornea for either group. Fisher's exact test comparison of the impression cytologic total scores after treatment revealed no difference between groups. Despite changes in some conjunctival parameters (e.g., cell-to-cell contact of epithelial cells, nucleus-to-cytoplasm ratio, level of organization of nuclear chromatin, goblet cell density, and keratinization), comparison of the total impression cytologic scores revealed no difference between groups.
... Thereafter similar ocular surface changes were found in several studies on Graves' disease. For example, İsmailova et al. detected worsening conjunctival structure in TAO by using impression cytology, vital staining and incisional biopsy methods (6,7,14,15). They state that vital staining may indicate absence of transmembrane and secretory mucin that protects the superficial epithelial cells. ...
... Even so, before the onset of overt findings of TAO, ocular surface inflammation (Grade 2-3 changes of CIC) can be the single clinical sign in Graves' disease (6,7). Inflammation is reported to be T cell mediated and pro-inflammatory agents like IL-1, MMP-9 and TNF-alpha are also associated with it (6,7,14). Similarly Gupta et al. reported dry eye in occult TAO, which was diagnosed by orbital echography in the dry eye patients with no classic clinical findings of TAO such as exophthalmos and lid retraction (16). ...
Article
Full-text available
Objective: To compare the conjunctival morphological changes in patients with Hashimoto's thyroiditis (HT) without thyroid-associated ophthalmopathy (TAO) and controls using impression cytology technique. Material and method: We included 25 HT patients and 33 healthy controls who did not have TAO findings or dry eye. For both groups, thyroid stimulating hormone (TSH), free T4(FT4), and anti-thyroid peroxidase (anti-TPO) were measured. Thyroid ultrasonography was performed, together with all routine eye check-ups and the Schirmer's test. Also, conjunctival impression cytology (CIC) test was performed to analyze the conjunctival morphology. Results: When the CIC of HT patients was observed; 12% had grade 0, 40% had grade 1, 28% had grade 2 and 20% had grade 3. While patients with squamous metaplasia made up 48% of the HT group, this was observed at 6.1% in the control group (p < 0,001). In the regression model formulated, it was observed that obesity (OR=7.500; p=0.017) and anti TPO levels (OR=1.370, p=0,007) were independent stipulations for the squamous metaplasia. Conclusion: Conjunctival squamous metaplasia was more frequently seen in HT than controls and serum Anti-TPO level and obesity were detected as independent predictors of the worsening at the conjunctival impression cytology.
... Almeida et al. in their cohort study, the relationship between autoimmune thyroid diseases and CCh, and concluded that autoimmune thyroid disease was a predisposing risk factor for CCh [22]. ...
... However, he described the fixation of the conjunctiva to the sclera with a 6-0 Vicryl suture [49]. In addition to surgical excision of the conjunctiva, the local conjunctiva is produced by electrocoagulation method and this method allows the conjunctiva to be firmly attached to the Tenon capsule [22]. Surgical techniques mentioned in the literature are listed below. ...
Article
Full-text available
Conjunctivochalasis is defined as a redundant, nonedematous conjunctiva that causes a wide variety of symptoms. Excess conjunctival tissue may not cause any symptoms and may cause some symptoms like subconjunctival hemorrhage, epiphora, dry eye findings and corneal ulceration. Disturbance of tear meniscus, impaired tear distribution and punctal occlusion play a role in the onset of symptoms. Although the etiopathogenesis of the disease is not yet clearly understood, several theories have been proposed. According to the mechanical theory, age-related mechanical changes in the conjunctiva lead to a chronic obstruction of the lymphatic flow and lymphatic dilatation after this chronic obstruction leads to conjunctivochalasis. According to inflammatory theory, collagenolytic activity increases as a result of inflammation on the ocular surface, causing degeneration of elastic fibers. As a result, degeneration of elastic fibers lead to alterations in the extracellular components of the conjunctival tissue. This inflammatory changes resulting in conjunctival laxity. Although conjunctivosalasis (CCh) is a clinical diagnosis, it is often overlooked by clinicians. CCh patients are can be symptomatic or asymptomatic. Medical and / or surgical treatment is generally needed in symptomatic patients, whereas treatment is not necessary in asymptomatic patients. Medical treatment is the first choice in the treatment of conjunctivochalasis. Artificial tear preparations are widely used in the treatment of CCh due to the deterioration of the tear film layer and dry eye symptoms. In clinical practice, topical anti-inflammatory eye drops are often preferred to reduce ocular surface inflammation. In cases where medical treatment is not sufficient, surgical treatment should be performed. Today, there are many studies showing that surgical treatment is effective in reducing ocular symptoms and ocular surface damage in patients with CCh and in cases with and without dry eye.The surgical treatment plan should include the loose conjunctival tissue located in the lower part, as well as the excess conjunctival tissue located in the nasal and temporal regions and aim to correct the tear meniscus along the entire lower lid margin. The most preferred surgical method is crescent excision of CCh tissue and primary suture of the conjunctiva. Other surgical approaches include fibrin glue and amniotic membrane transplantation and direct scleral suture of CCh tissue. Another surgical method is electrocauterization of the conjunctival tissue. It is applied 5 mm away from limbus and there is no harm to fornixes.
... CCH is also characterized by the existence of severe squamous metaplasia (grade 4), in which the conjunctival epithelial cells often present a keratinized cytoplasm (depending on the degree of CCH). 24 Here, we have found overexpression of the keratin type I cytoskeletal 10 protein (31.81 fold upregulation) in samples of CCH tears. In Sjögren syndrome, this protein is related to keratinization of cells of the conjunctival epithelium. ...
Article
Full-text available
To compare the protein profiles of tears from normal volunteers and patients with conjunctivochalasis (CCH), with a view to identifying proteins whose expression is altered in this pathology. Tears from 8 normal subjects and 6 patients with CCH were analyzed by 2-dimensional electrophoresis. Total protein from tears was separated in the first dimension by isoelectric focusing, and the second dimension was carried out using 8%-16% sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The gel images were analyzed using Progenesis SameSpot software. Those spots of interest were manually cut out from the gels, and the corresponding proteins were identified by matrix assisted laser desorption/ionization-time of flight (MALDI-TOF). Expression levels of proteins that had been found to be significantly altered were further verified by Western blot. Approximately 250 spot proteins were detected in the whole tear proteome. Twenty-four spots were significantly upregulated in CCH compared with that in controls. Eleven protein spots were identified, which included proteins belonging to the S100 family (A8, A9, A4; 2.44, 1.71, and 2.82 fold upregulation, respectively), guanosine triphosphate-binding protein 2 (1.95 fold), l-lactate dehydrogenase A-like 6B (2.32 fold), fatty acid-binding protein (2.01 fold), keratin type I cytoskeletal 10 (1.81 fold), glutathione S-transferase P (2.27 fold), peroxiredoxin-1, peroxiredoxin-5 (1.79- and 1.92 fold, respectively), and cullin-4B+ glyceraldehyde 3-phosphate dehydrogenase (1.96 fold). We have identified a group of proteins, which is upregulated in CCH tears. Although some of them, such as S100A4, S100A8, and peroxiredoxin-5, are markers of inflammation and oxidative processes, monitoring their levels in CCH might be useful for assessing the severity and progression of the disease.
... Table 1 presents the characteristics of the study population. None of the patients had thyroid disease [18], which is a known risk factor for conjunctivochalasis. ...
Article
Full-text available
The purpose of this study was to evaluate the changes in the severity of conjunctivochalasis after cataract surgery performed via a superior conjunctival sclerocorneal incision. Prospective investigation was performed in a consecutive series of 36 eyes of 36 patients aged 62–85 years who underwent phacoemulsification and implantation of a 6.0-mm foldable intraocular lens through a 2.8-mm superior sclerocorneal incision. The age, gender, medical history, ocular history, grade, refraction, and axial length were determined in all subjects. The conjunctivochalasis score (0–3) and other parameters were determined at three sites (nasal, middle, and temporal) according to the system for grading conjunctivochalasis proposed by Meller and Tseng (at baseline and at 1, 4, and 12 weeks postoperatively). The total conjunctivochalasis score (sum of the scores for the temporal, middle, and nasal regions: 0–9) increased significantly from 4.0 ± 1.9 at baseline to 4.8 ± 2.1 at 1 week postoperatively (p = 0.0048), and subsequently decreased again at 4 weeks (4.3 ± 2.0) and 12 weeks (4.0 ± 1.9). Multivariate logistic regression analysis showed that progression of conjunctivochalasis at 12 weeks was significantly associated with the axial length [odds ratio (OR) = 1.21, p = 0.0118] and with conjunctival suture placement (OR = 1.34, p = 0.0493). When cataract surgery was performed via a superior sclerocorneal incision, the severity of conjunctivochalasis at 12 weeks postoperatively was similar to that at baseline. Our findings suggest that a superior sclerocorneal incision has no influence on the progression of conjunctivochalasis after cataract surgery.
... In a recent study, patients with autoimmune thyroid disease (88%) presented with higher rates of CCh than the control group, thus establishing a possible association between thyroid disease and conjunctivochalasis. 37 Similarly superior limbic keratitis 38 and Ehler Danlos disease 39 were reported as in association with CCh. Further studies are required to explore relationships between systemic associations and CCh. ...
Article
Full-text available
Purpose To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). Methods and materials This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.
... The characteristics of the study population are presented in Table 1. Among the patients, 16.8% had hypertension, 5.9% had diabetes, 2.1% had hyperlipidaemia, 2.8% had a history of coronary heart disease and 0.3% had thyroid disease, which is a known risk factor for conjunctivochalasis (de Almeida et al. 2006). With respect to ocular diseases, a total of 179 patients (16.9%) had cataract, 52 patients (4.9%) had glaucoma and four patients (0.4%) had diabetic retinopathy (Table 1). ...
Article
Purpose: To assess the relationship between the prevalence and severity of conjunctivochalasis and pinguecula. Methods: Cross-sectional, consecutive case study conducted at the university hospital of University of Tokyo Graduate School of Medicine. A total of 1061 patients aged from 1 to 94 years were enrolled. The grade and other parameters of conjunctivochalasis (classified into three locations: nasal, middle and temporal) and the grade of pinguecula located on the nasal or temporal conjunctiva were determined in all subjects. Patients were also divided into 5 or 10 age groups. Results: The severity of conjunctivochalasis affecting the nasal and temporal bulbar conjunctiva was significantly correlated with the grade of pinguecula located on the nasal and temporal conjunctiva in each age group (p < 0.05). Pinguecula was independently associated with conjunctivochalasis (nasal: odds ratio [OR] = 1.44; temporal: OR = 1.43) after adjustment for age. Conclusion: This was the first assessment of the relation between the grade of conjunctivochalasis and pinguecula in a large consecutive series of patients. Our results suggest that the prevalence and severity of conjunctivochalasis are related to the presence of pinguecula.
Article
Introduction The lid margins are essential to maintain a healthy tear film and distribute it over the ocular surface to achieve an optimal refractive interface. Alterations in the lid margin structures and function may lead to significant ocular surface problems. Meibomian gland dysfunction is usually attributed to be the most common reason for ocular surface disease. However, the lid margin disease cannot be fully understood and adequately addressed if the function of the meibomian glands is not evaluated in relation to other lid margin structures. Areas covered This review aims to emphasize that the lid margin requires a full assessment in order to address ocular surface diseases associated with lid margin disease. The different zones of the lid margin and their roles in the maintenance of ocular surface health are delineated. Alterations in the lid margin structures due to increasing age or underlying etiology and their potential impact are discussed. Expert commentary If structural abnormalities are not recognized and properly addressed, the treatment of meibomian gland dysfunction will likely fail. Future studies focusing on the underlying etiology of structural alterations will hopefully lead to the development of more effective therapeutic options.
Article
To assess the relationship between age and the incidence and severity of conjunctivochalasis in contact lens (CL) wearers by grading of conjunctivochalasis, and to compare the severity of conjunctivochalasis between CL wearers and nonwearers. Prospective, nonrandomized consecutive case study. A total of 600 CL wearers (94 hard CLs [HCL] and 506 soft CLs [SCL]) aged 11 to 60 years and 579 nonwearers aged 10 to 60 years were enrolled. The age, gender, medical history, ocular history, and the grade and other parameters of conjunctivochalasis at 3 locations (nasal, middle, and temporal areas) were determined in all subjects. The prevalence of conjunctivochalasis increased dramatically with age in all groups. The mean grade of conjunctivochalasis was higher in CL wearers than in nonwearers (nasal area, P < .00001; temporal area, P < .00001) and was higher in HCL wearers than in SCL wearers (nasal area, P < .00001; temporal area, P = .00003). Parameters such as the downward gaze-dependent or digital pressure-dependent changes of conjunctivochalasis and the presence of superficial punctate keratitis all increased with age in both CL wearers and nonwearers. The gaze-dependent and pressure-dependent changes of conjunctivochalasis showed an increase with age and the duration of CL wear in both SCL and HCL wearers. This was the first assessment of the severity of conjunctivochalasis in a large series of consecutive CL wearers. Our results strongly suggest that wearing CLs is an important risk factor for conjunctivochalasis.
Article
To report impression cytologic (IC) results after corneal cross-linking (CXL) using riboflavin and ultraviolet-A light in the treatment of keratoconus and compare the data with those from a group of subjects with the same disease. Forty eyes were distributed into 2 groups: patients in group 1 underwent CXL, whereas patients in group 2 received riboflavin 0.1% eyedrops for 1 month of topical use. IC specimens were obtained from all eyes before treatment and 1 and 3 months after treatment. Patients in group 1 showed a decrease in goblet cell density on the superior conjunctiva after CXL (P = 0.008) but no difference on the temporal conjunctiva or in the cornea. Patients in group 2 demonstrated improvement in cell-to-cell contact of epithelial cells and reduced keratinization on the temporal conjunctiva after treatment (P = 0.003 and P = 0.034, respectively) but no changes on the superior conjunctiva or in the cornea. Fisher exact test comparison of IC total scores after treatment revealed no difference between groups. Despite changes in goblet cell density after corneal CXL in the superior conjunctiva and an improvement in the morphology of epithelial cells after the use of riboflavin eyedrops, comparison of total IC scores showed no difference between groups.
Article
To examine the histopathology of palpebral conjunctiva in patients with thyroid-related orbitopathy. Based on previously published anecdotes, the hypothesis is that conjunctiva shows increased inflammation and fibrosis. This was a comparative case series. Superior palpebral conjunctiva was examined from two groups. The study group consisted of 20 patients undergoing thyroid-related upper eyelid retraction surgery. The control group consisted of 18 patients undergoing ptosis repair. Specimens were processed and stained using hematoxylin and eosin and trichrome. Histopathologic grading was performed using light microscopy. Main outcome measures were degree of inflammation and fibrosis, mast cell infiltration, and fibroblast count. The two groups did not differ with regard to age or gender. Mean degree of inflammation was 1.4 (95% CI: 0.9, 1.9) for the control group and 1.7 (95% CI: 1.3, 2.1) for the study group. Relative intensity of blue from trichrome staining mean was 134.3 (95% CI: 130.3, 138.3) for the control group and 138.6 (95% CI: 133.7, 143.6) for the study group. The Mann-Whitney test showed no difference between groups in inflammation (P=.17), relative blue intensity (P=.11), degree of mast cell infiltration (P=.61), and fibroblast count (P=.45). Point estimates show a trend toward greater inflammation in the study group. While there is a trend toward higher inflammation in the study group, the superior palpebral conjunctiva of patients with thyroid-related orbitopathy is largely spared from autoimmune changes. This has implications in surgical approaches to eyelid retraction repair.
Article
Full-text available
To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). LWE was significantly correlated to both temporal and nasal LIPCOF (0.537<r<0.607, P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944). The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.
Article
To assess the relation between the prevalence and grade of conjunctivochalasis and refractive error and to compare the grade of conjunctivochalasis between myopic and hyperopic patients. Consecutive patients aged from 3 to 94 years were chosen for this study. Exclusion criteria included a history of using contact lenses, ocular surgeries, infectious conjunctivitis, or corneal diseases. The age, gender, medical history, ocular history, the grade and other parameters of inferior conjunctivochalasis classified into three locations (nasal, middle, and temporal), and refractive error were determined in all subjects. Patients were divided into three groups as follows: a hyperopic group (≥0.0 D), an emmetropic group (<0.0 and ≥-2.0 D), and a myopic group (<-2.0 D). They were also divided into 10 groups according to age. One-way analysis of variance and the Scheffe multiple comparison test were used to compare the mean values among three groups. Relations among the variables were investigated by calculating Pearson correlation coefficients and partial correlation coefficients. A total of 1,110 patients were included in the study. In each age group, the mean grade of conjunctivochalasis was higher in hyperopic patients than in myopic patients. There were no significant differences in both the downward gaze- and digital pressure-dependent changes of conjunctivochalasis between the myopic and hyperopic groups. The severity of conjunctivochalasis affecting the nasal and temporal bulbar conjunctiva, and parameters such as the changes of conjunctivochalasis caused by downward gaze or digital pressure, were correlated with the refractive error, especially in patients over 40 years old (P<0.05). This was the first assessment of the relationship between refractive error and the grade of conjunctivochalasis in a large consecutive series of patients. Our results suggest that the prevalence and grade of conjunctivochalasis are dependent on refractive error, with hyperopia being an important risk factor for conjunctivochalasis.
Article
Purpose: To investigate the relation between the severity of conjunctivochalasis and the axial length (AL) of the eyeball. Methods: A prospective nonrandomized study was performed on 165 patients aged 51 to 88 years. The age, gender, medical history, ocular history, grade and other parameters of inferior conjunctivochalasis (classified as nasal, middle, and temporal), and AL were determined in all patients. Patients were divided into a short AL group (≤ 22.0 mm), a medium AL group (>22.0 to ≤ 24.0 mm), and a long AL group (>24.0 mm). Results: The short AL group tended to have higher grades of temporal and nasal conjunctivochalasis compared with the medium and long AL groups. Multivariate logistic regression analysis showed that the total conjunctivochalasis score (the sum of the scores for the temporal, middle, and nasal regions) was significantly associated with the age [odds ratio (OR) = 1.32, P = 0.001] and the AL (OR = 0.81, P = 0.029). In addition, the AL was independently associated with the grade of conjunctivochalasis after adjustment for age (OR = 0.80, P = 0.020). Conclusions: This was the first assessment of the relationship between the AL and the grade of conjunctivochalasis. Our findings suggest that the severity of conjunctivochalasis is dependent on the AL, with a short AL contributing to the pathogenesis of conjunctivochalasis.
Article
Goblet cells of the conjunctiva are the main source of mucus for the ocular surface. The objectives of this review are to consider the goblet cells as assessed by various histological, cytological and electron microscopy methods, and to assess the consistency of published reports (over more than 25 years) of goblet cell density (GCD) from impression cytology specimens from nominally healthy human subjects. Reported GCD values have been notably variable, with a range from 24 to 2226 cells/mm² for average values. Data analysis suggests that a high density of goblet cells should be expected for the healthy human conjunctiva, with a tendency toward higher values in samples taken from normally covered locations (inferior and superior bulbar conjunctiva) of the open eye (at 973 +/- 789 cells/ mm²) than in samples taken from exposed (interpalpebral) locations (at 427 +/- 376 cells/mm²). No obvious change in GCD was found with respect to age, perhaps because the variability of the data did not allow detection of any age-related decline in GCD. Analyses of published data from 33 other sources indicated a trend for GCD to be lower than normal across a spectrum of ocular surface diseases.
Article
Comprehensive, yet concise and clinically oriented, the new edition of Ocular Pathology brings you the very latest advances of every aspect of ocular pathology. From updated information on today's imaging techniques, to the implementation of genetic data to better understand disease, this esteemed medical reference book promises to keep you at the forefront of your fieldTake advantage of clinical "pearls" that offer you the benefits of proven strategies.Quickly reference information with help from a convenient outline format, ideal for today's busy physician. Visualize every concept by viewing 1,900 illustrations, 1,600 of which are in full color, from the collections of internationally renowned leaders in ocular pathology.
Article
Conjunctivochalasis, an age-related disease, there's more and more patients due to aging. The high tension of inferior palpebra margin, movement of eyeball and block of lymph liquid could be the risk factor of conjunctivochalasis. The incidence of conjunctivochalasis is high among patients of auto-immune thyroid disease. The tear excretion is reduced and the stability of tear membrane dropped, and there's less mucoprotein in the tear. The amount of cup cell in bulbar conjunctiva is reduced as long as the severity of conjunctivochalasis is increased, and with morphological and micro-structure abnormally. There are 356 proteins in the tear of conjunctivochalasis patients while there are 352 proteins in the tear of healthy people. There are 237 different proteins between patient and healthy people. There's protein related to apoptosis and protecting factor. The mechanism of conjunctivochalasis is considered an increase of a series of inflammation factors such as IL-1beta and IL-6, thus a hyper expression of MMP-1,3,9 in fibroblast of conjunctiva and imbalance between MMPs and TIMPs. That will breakdown the collagen fibrils and a degeneration of elastic fibrils occurred, thus there's a hyper degradation of ground substance of bulbar conjunctiva and Tenon's capsule, that makes an abnormally of tear and then conjunctivochalasis. The glue of fibro protein has been used in the surgical operation for conjunctivochalasis and new operation method with electronic coagulation has been used for patient of conjunctivochalasis.
Article
Objectives: To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population. Methods: This population-based study was conducted in the context of the second phase of Shahroud Eye Cohort Study in 2014. Of 4,737 participants aged 45 to 69 years who participated in the second phase, the data of 4,702 participants were available for this report. A diagnosis of conjunctivochalasis was made based on the physician's judgment on ophthalmic examinations. Results: Diagnosis of conjunctivochalasis in at least one eye was confirmed in 295 (6.2%) participants. The prevalence of unilateral and bilateral conjunctivochalasis was 0.7% and 5.5%, respectively. Older age (odds ratio [OR] = 1.96, 95% confidence interval [CI]: 1.22-3.15), use of Losartan (an angiotensin II receptor antagonist) (OR=1.47, 95% CI: 1.05-2.08), Meibomian Gland Dysfunction (OR=2.32, 95% CI: 1.78-3.03), Pinguecula (OR=0.57, 95% CI: 0.42-0.77), and blepharitis (OR=0.24, 95% CI: 0.07-0.77) had a significant association with conjunctivochalasis. Conclusion: The prevalence of conjunctivochalasis in our study was less than other reports from Asian population. Conjunctivochalasis has a significant association with some eyelid disorders and the use of Losartan which should be noted when diagnosing and treating this disease.
Article
Full-text available
L’adolescence est un moment clé en termes de repérage du mal-être et des comportements à risque. Le repérage précoce et intervention brève (RPIB jeunes) a ainsi été développé à destination, notamment, des médecins gé- néralistes. Il s’agit d’un repérage par des tests validés puis d’une intervention reprenant les postures de l’écoute active, avec une approche centrée patient.
Article
Full-text available
The PubMed, MEDLINE databases and China National Knowledge Infrastructure (CNKI) were searched for information regarding the etiology and pathogenesis of conjunctivochalasis (CCh) and the synthesis and degradation of elastic fibers. After analysis of the literature, we found elastic fibers was a complex protein molecule from the structure and composition; the degradation of elastic fibers was one of the histopathological features of the disease; the vast majority of the factors related to the pathogenesis of CCh ultimately pointed to abnormal elastic fibers. By reasonably speculating, we considered that abnormal elastic fibers cause the conjunctival relaxation. In conclusion, we hypothesize that elastic fibers play an important role in the pathogenesis of CCh. Studies on the mechanism of synthesis, degradation of elastic fibers are helpful to clarify the pathogenesis of the disease and to find effective treatment methods.
Article
To assess the relationship between age and the incidence and severity of conjunctivochalasis by using the grading system for conjunctivochalasis proposed by Meller and Tseng. Prospective, nonrandomized, consecutive case study. A total of 1,416 patients aged one to 94 years were enrolled. The age, gender, medical history, ocular history, and grade and parameters of conjunctivochalasis at three locations (nasal, middle, and temporal) were determined in all subject. The prevalence of conjunctivochalasis increased dramatically with age (one to 10 years, 6.8%; 11 to 20 years, 36.2%; 21 to 30 years, 61.5%; 31 to 40 years, 71.4%; 41 to 50 years, 90.2%; 51 to 60 years, 94.2%; 61 to 70 years, 98.0%; 71 to 80 years, 99.0%; 81 to 90 years, 98.5%; and 91 to 100 years, 100.0%). The mean grade of conjunctivochalasis was higher in female patients than in male patients (nasal area, P = .0229; temporal area, P = .0078) and was higher for the temporal conjunctiva than the nasal conjunctiva (P < .0000001). Parameters such as the downward gaze- or digital pressure-dependent changes of conjunctivochalasis and the presence of superficial punctate keratitis all increased with age. These conjunctivochalasis-related parameters were correlated with the severity of conjunctivochalasis (P < .00001), especially of the middle bulbar conjunctiva. We report the grade of conjunctivochalasis in a large series of consecutive patients. Our results strongly suggest that conjunctivochalasis is an age-dependent eye disease that occurs in young adulthood and thereafter. The present grading system should be useful for future clinical studies of conjunctivochalasis.
Article
Full-text available
The alterations in the conjunctival epithelium during the course of vernal conjunctivitis were examined by conjunctival impression cytology. The study was carried out on 53 patients with vernal conjunctivitis and 20 normal subjects as control. The results of impression cytology demonstrated that all cytological parameters were significantly modified in vernal conjunctivitis patients; the earliest alterations were found in the distribution of goblet cells, in the intercellular junctions, in the chromatin morphology and in the degree of keratinisation. The morphometric comparison showed that in vernal conjunctivitis patients the mean number of goblet cells per field was significantly higher than in controls. Moreover the mean diameter of goblet cells was smaller in patients than in controls. Impression cytology can, therefore, be a simple, non-invasive and cheap method for the study of the ocular surface in vernal conjunctivitis.
Article
Full-text available
To examine the expression patterns of extracellular matrix degrading enzymes in cultured primary pterygium body fibroblasts activated by cytokines and growth factors potentially derived from ocular surface epithelial cells and tears. EGF, TGF-alpha, PDGF-BB, IL-1beta, bFGF, TGF-beta1, TNF-alpha, or IL-6 were added at 10 ng/ml to early passaged primary pterygium body fibroblasts (PBF) or normal human conjunctival fibroblasts (HJF) in a serum-free medium. Expression of transcripts and proteins of MMP-1, MMP-2, MMP-3, MMP-9, TIMP-1, TIMP-2, and uPA was determined by Northern hybridization, ELISA, and Western blotting, respectively. Gelatin and casein zymographies were performed in their serum-free conditioned media with or without enzyme inhibitors to determine the activity of MMP-2 and -3, respectively. IL-1beta and TNF-alpha dramatically increased the mRNA and protein expression of MMP-1 and MMP-3 in cultured PBF when compared to normal HJF and to their nonstimulated counterparts cultured in a serum-free medium. EGF and TGF-alpha also upregulated MMP-3 in PBF when compared to HJF. The transcript levels of MMP-2 were high but stable for the two cell types regardless of the cytokine treatment. Both TIMP-1 and TIMP-2 expressions were not influenced by the cell type or the cytokine treatment. MMP-9 was not expressed in either of these two types of fibroblasts. Both IL-1beta and TNF-alpha induced a significant decrease in uPA expression in PBF, whereas bFGF induced a slight increase in both HJF and PBF. Chronic inflammatory stimulation by IL-1beta and TNF-alpha, which potentially can be derived from the ocular surface and tears, may be responsible for increased expression of MMPs in cultured PBF. These data have clinical implications on progression of pterygium and recurrence associated with incomplete excision of primary PBF under the influence of ocular surface inflammation. Suppression of intraoperative and postoperative inflammation may be a new strategy to prevent pterygium recurrence.
Article
Full-text available
Overexpression and increased activities of matrix metalloproteinases (MMPs) have recently been reported in cultured conjunctival fibroblasts from patients with conjunctivochalasis. The role of inflammatory cytokines in modulating expression of MMPs, their tissue inhibitors (TIMPs), and urokinase plasminogen activator (uPA) as potential contributors to the pathogenesis of conjunctivochalasis was investigated. Interleukin-1beta (IL-1beta) or tumor necrosis factor-alpha (TNF-alpha) was added at 10 ng/ml to a serum-free medium. Expression of transcripts and proteins of MMPs, TIMPs, and uPA by cultured normal human conjunctival and conjunctivochalasis fibroblasts was determined by Northern hybridization, enzyme-linked immunosorbent assay (ELISA) and Western blot analysis, respectively. Gelatin and casein zymographies were performed in serum-free conditioned media with and without the respective enzyme inhibitors. Without challenging the cells, conjunctivochalasis fibroblasts showed mRNA and protein overexpression of MMP-1 and MMP-3 compared with normal conjunctival fibroblasts, which showed minor or no expression of these enzymes. IL-1beta markedly and TNF-alpha to lesser extent increased mRNA and protein expression of MMP-1 and MMP-3 in conjunctivochalasis fibroblasts from 2 subjects when compared with normal conjunctival fibroblasts from 2 subjects and with their nonstimulated counterparts. In conjunctivochalasis fibroblasts and normal conjunctival fibroblasts, TNF-alpha, but not IL-1beta, induced a gelatinolytic activity of MMP-9, which was further confirmed by Western blot analysis and ELISA. Expression of MMP-2, TIMP-1, and TIMP-2 mRNA and protein was not influenced by IL-1beta or TNF-alpha, and no difference was found in the gelatinolytic activity of MMP-2 between both cell types. Inflammatory cytokines such as IL-1beta and TNF-alpha, which can potentially be derived from the ocular surface and tears, may be responsible for increased expression of MMPs in cultured conjunctivochalasis fibroblasts. Ocular inflammation might be one important denominator in the pathogenesis of conjunctivochalasis.
Article
Full-text available
To present our experience with the use of preserved human amniotic membrane on patients with epiphora caused by conjunctivochalasis. Twelve patients, seven women and five men, ages ranging from 56 to 72 years (mean, 61 years) were referred to our Cornea Service with chronic epiphora. In all patients, no punctal ectropion was present, the lacrimal pathway was patent, and the dye disappearance test was abnormal. All patients had already undergone various therapies including multiple irrigations of the lacrimal system, antibiotic drops, steroid drops, and artificial tear drops. In all patients, conjunctivochalasis, which was not previously diagnosed, was evident on slit-lamp examination. After surgical removal of the excess conjunctiva, preserved human amniotic membrane was placed over and sutured with 10-0 nylon continuous suture to the free conjunctival edges. During the postoperative period, artificial tear drops and steroid/antibiotic drops were applied. Improvement of the epiphora was evident from the first postoperative day. After removal of the suture 10 to 15 days (mean, 12 days) after surgery, no patient complained of epiphora. The dye disappearance test was normal. During the follow-up period, which ranged from 6 to 11 months (mean, 8 months), no patient complained of epiphora and no conjunctivochalasis was detected in the area in which human amniotic membrane was transplanted. In our experience, transplantation of preserved human amniotic membrane greatly improved symptoms of epiphora caused by conjunctivochalasis. Continued education of the general ophthalmologists concerning this condition is required.
Article
PURPOSE. Overexpression and increased activities of matrix metalloproteinases (MMPs) have recently been reported in cultured conjunctival fibroblasts from patients with conjunctivochalasis. The role of inflammatory cytokines in modulating expression of MMPs, their tissue inhibitors (TIMPs), and urokinase plasminogen activator (uPA) as potential contributors to the pathogenesis of conjunctivochalasis was investigated. METHODS. Interleukin-1 beta (IL-1 beta) or tumor necrosis factor-alpha (TNF-alpha) was added at 10 ng/ml to a serum-free medium. Expression of transcripts and proteins of MMPs. TIMPs, and uPA by cultured normal human conjunctival and conjunctivochalasis fibroblasts was determined by Northern hybridization, enzyme-linked immunosorbent assay (ELISA) and Western blot analysis, respectively. Gelatin and casein zymographies were performed in serum-free conditioned media with and without the respective enzyme inhibitors. RESULTS. Without challenging the cells, conjunctivochalasis fibroblasts showed mRNA and protein overexpression of MMP-1 and MMP-3 compared with normal conjunctival fibroblasts, which showed minor or no expression of these enzymes. IL-1 beta markedly and TNF-alpha to lesser extent increased mRNA and protein expression of MMP-1 and MMP-3 in conjunctivochalasis fibroblasts from 2 subjects when compared with normal conjunctival fibroblasts from 2 subjects and with their nonstimulated counterparts. In conjunctivochalasis fibroblasts and normal conjunctival fibroblasts, TNF-alpha but not IL-1 beta, induced a gelatinolytic activity of MMP-9, which was further confirmed by Western blot analysis and ELISA. Expression of MMP-2, TIMP-1, and TIMP-2 mRNA and protein was not influenced by IL-1 beta or TNF-alpha, and no difference was found in the gelatinolytic activity of MMP-2 between both cell types. CONCLUSIONS. Inflammatory cytokines such as IL-1 beta and TNF-alpha, which can potentially be derived from the ocular surface and tears, may be responsible for increased expression of MMPs in cultured conjunctivochalasis fibroblasts. Ocular inflammation might be one important denominator in the pathogenesis of conjunctivochalasis.
Article
Purpose. To present our experience with the use of preserved human amniotic membrane on patients with epiphora caused by conjunctivochalasis. Methods. Twelve patients, seven women and five men, ages ranging from 56 to 72 years (mean, 61 years) were referred to our Cornea Service with chronic epiphora. In all patients, no punctal ectropion was present, the lacrimal pathway was patent, and the dye disappearance test was abnormal. All patients had already undergone various therapies including multiple irrigations of the lacrimal system, antibiotic drops, steroid drops, and artificial tear drops. In all patients, conjunctivochalasis, which was not previously diagnosed, was evident on slit-lamp examination. After surgical removal of the excess conjunctiva, preserved human amniotic membrane was placed over and sutured with 10-0 nylon continuous suture to the free conjunctival edges. During the postoperative period, artificial tear drops and steroid/antibiotic drops were applied. Results. Improvement of the epiphora was evident from the first postoperative day. After removal of the suture 10 to 15 days (mean, 12 days) after surgery, no patient complained of epiphora. The dye disappearance test was normal. During the follow-up period, which ranged from 6 to 11 months (mean, 8 months), no patient complained of epiphora and no conjunctivochalasis was detected in the area in which human amniotic membrane was transplanted. Conclusion. In our experience, transplantation of preserved human amniotic membrane greatly improved symptoms of epiphora caused by conjunctivochalasis. Continued education of the general ophthalmologists concerning this condition is required.
Article
To the Editor. —The superior limbic filamentous keratitis as described by Theodore has, to date, no specific etiology. An interesting finding on three or four patients with this condition has been a markedly elevated protein-bound iodine value, and all patients have subsequently been found to be completely asymptomatic of hyperthyroidism. The fourth patient was on a dietetic regimen taking from 0.260 to 0.390 gm of thyroid extract per day. I think this is a most interesting finding in this disease and whether or not it has some connection with the etiology has yet to be determined. The main purpose of this correspondence is to bring this finding to the attention of other ophthalmologists around the country so that a larger series of these patients might be examined specifically for hyperthyroidism to see if this finding holds true.
Article
In Sydney, Australia, ten patients affected by superior limbic keratoconjunctivitis (SLKC) have been observed in one ophthalmic practice during a four-year period. Among the ten patients, three were found to be actively thyrotoxic, and two others had already undergone treatment for proven hyperthyroidism. Reference is made to a possible etiological contribution by the special anatomy of the upper conjunctival fornix and by secretions entering the conjunctival sac. The association with thyrotoxicosis revives the matter of an immunological (possibly auto-immune) origin for SLKC. A viral-induced mechanism has not been excluded.
Article
Dry eye syndromes are becoming more important for the ophthalmologist. Various circumstances lead to a significant impairment of the three layered precorneal film, whose disturbed equilibrium causes diverse pathological changes in the ocular surface. Apart from symptoms and clinical signs, various clinical tests and laboratory procedures can be used to confirm the diagnosis. We looked at the utility of the lid-parallel conjunctival fold (LIPCOF) with regard to the diagnosis "dry eye". In this publication we describe and classify LIPCOF, stage 0 to stage 3, and investigate its relationship to the severity of dry eye. Dryness is determined by the "sicca score", a scale between 0 and 12 based on a wide-ranging spectrum of tests, including the Schirmer I-test, tear-film break-up time, rose bengal and and fluorescein staining, the lysozyme test and impression cytology. In this prospective study we examined one eye in each of 267 patients, assigning them to one of two groups based on the absence or presence of LIPCOF. These two groups are comparable in gender and age (group-matching). For the diagnosis of dry eye, using LIPCOF, statistical analysis of the data showed a negative predictive value of 75.95% and a positive predictive value of 93.09%. The correlation pattern of LIPCOF with the patient's medical history and slit-lamp. They are a dependable diagnostic sigh of dry eye. Consideration and classification of LIPCOF enlarges and facilitates diagnosis of dry eye syndromes by the ophthalmologist.
Article
Conjunctivochalasis, defined as a redundant conjunctiva typically located between the globe and the lower eyelid, is not uncommon. However, it is often overlooked, as it may be considered a normal senile change. Conjunctivochalasis can cause a spectrum of symptoms, ranging from aggravation of a dry eye at the mild stage, to disturbance of tear outflow at the moderate stage, and exposure problems at the severe stage. Clinical recognition of its pathogenic role helps differentiate conjunctivochalasis from other diseases that may generate similar symptoms. For symptomatic patients, topical lubricants can be tried, but they are frequently unsuccessful, and surgical excision may be required. To guide future investigation into the clinical significance of conjunctivochalasis, a comprehensive grading system and a hypothetical pathophysiology are proposed. Special attention is given to the relationship of conjunctivochalasis to tear dynamics.
Article
To study superior limbic keratoconjunctivitis in a relatively large group of patients and to determine whether a relation exists with thyroid dysfunction. The medical records of 57 patients with superior limbic keratoconjunctivitis who were examined between 1980 and 1993 were reviewed. Thirty-seven patients (64.9%; 95% confidence interval, 51.1-77.1) had objective evidence of thyroid dysfunction. Of patients with superior limbic keratoconjunctivitis and thyroid disease, 33 (89.2%) had ophthalmopathy, which in 16 patients (48.5%) was sufficiently severe to require orbital decompression. Superior limbic keratoconjunctivitis is associated with thyroid dysfunction and appears to be a prognostic marker for severe Graves ophthalmopathy.
Article
Conjunctivochalasis, defined as a redundant conjunctiva typically located between the globe and the lower eyelid, is not uncommon. However, it is often overlooked, as it may be considered a normal senile change. Conjunctivochalasis can cause a spectrum of symptoms, ranging from aggravation of a dry eye at the mild stage, to disturbance of tear outflow at the moderate stage, and exposure problems at the severe stage. Clinical recognition of its pathogenic role helps differentiate conjunctivochalasis from other diseases that may generate similar symptoms. For symptomatic patients, topical lubricants can be tried, but they are frequently unsuccessful, and surgical excision may be required. To guide future investigation into the clinical significance of conjunctivochalasis, a comprehensive grading system and a hypothetical pathophysiology are proposed. Special attention is given to the relationship of conjunctivochalasis to tear dynamics.
Article
The aim of this pilot study was to relate the eye symptoms complained of by subjects working in the operating rooms of a hospital in southern Italy, with the observations of alterations of the ocular surface. An epidemiological study was carried out by a questionnaire aimed at investigating the prevalence of ocular discomfort symptoms among 213 subjects working in operating rooms and 40 subjects working in the wards. The investigated symptoms were the following: tiredness, heaviness, burning, redness, tearing, itching, blinking, foreign body sensation, and photophobia. A randomised comparative study of the ocular surface and conjunctival cytology was also carried out, comparing two groups of age- and gender-matched subjects. Group 1 included 24 subjects randomly chosen from the operating room workers with ocular discomfort symptoms; group 2 included ten subjects randomly enrolled from hospital personnel working in the wards. Ophthalmological examination of the ocular surface was performed on each subject in the following order: slit-lamp examination, break-up time (BUT) of the pre-corneal tear film, corneal fluorescein stain, lachrymal basal secretion test, conjunctival impression cytology. A high prevalence (72.3%) of ocular discomfort symptoms was reported by operating room workers, while in ward personnel the prevalence was 55% (P = 0.04). The ocular tests showed that the conjunctival features and BUT were statistically significantly altered in subjects in group 1. Also, the conjunctival impression cytology study showed statistically significant alterations of all the investigated parameters: specimen cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin pattern, goblet cell distribution, keratinisation and the total cytological score. Our results show that self-reported eye complaints and ocular surface alterations have a high prevalence in subjects working in the operating rooms. This seems to indicate that the operating room environment could play a role in the onset of the eye disturbances.
Article
To clarify the structural features of conjunctivochalasis histopathologically. A biopsy of redundant conjunctiva from the same anatomic location of 44 +/- 7.5 years (mean +/- SD, 50.87 years), underwent conjunctivoplasty (termed tear meniscus reconstruction). In all 44 cases, histologic examination disclosed normal conjunctival epithelium and negligible inflammation and lymphocyte infiltration; 39 patients manifested microscopic lymphangiectasia. Elastica van Gieson staining demonstrated elastic fiber fragmentation and sparsely assembled collagen fibers in all 44 cases. There was no discernible difference between specimens from patients with and without complications including tear-deficient dry eye, meibomian gland dysfunction, and clinically observable lymphangiectasia and/or pinguecula. Based on our histopathologic findings, we hypothesize that mechanical forces between the lower lid and conjunctiva gradually interfered with lymphatic flow. Chronic, prolonged mechanical obstruction of lymphatic flow may result in lymphatic dilation and eventually give rise to clinical conjunctivochalasis.
Article
To introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis. Interventional case series. Six eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o'clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis. In all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. Our treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.
Lidparrallele konjunktivale Falten(LIPCOF) sind ein sicheres diagnostisches Zeichen des trockenen Auges.
  • Hoh
Conjunctivochalasis.
  • Hughes
Das trockene auge. Symptomatik, ursache-diagnose, therapie.
  • Rieger