Conjunctivochalasis (CCh) is a condition characterized by multiple folds in the conjunctiva, the clear covering of the white part of the eye (called the sclera). After years of eye rubbing, aging, genetic risk factors, the conjunctiva no longer adheres closely to the sclera and the conjunctiva becomes loose with redundant conjunctival folds. These folds sometimes do not cause symptoms but often cause foreign body sensation due to their presence and/or due to tear distribution [, , ]. This condition is also characterized by bloodshot eyes, subconjunctival hemorrhage (popped surface blood vessel), chronic tearing (ie, epiphora), dry eye, and corneal ulceration [, , ]. It can also cause tear meniscus disruption, impaired tear distribution, and punctal occlusion (ie, the whole that drains tears to the nose). [, ].
Treatment (Reference 7):
Int Ophthalmol. 2018 Jul 10. doi: 10.1007/s10792-018-0963-6. [Epub ahead of print]
Investigation of conjunctivochalasis histopathology with light and electron microscopy in patients with conjunctivochalasis in different locations.
To investigate changes in conjunctival tissue of conjunctivochalasis (CCh) patients and to determine the relationship between pathological findings and localization of loose conjunctiva.
Our study included nineteen eyes of 19 patients who were referred to Cukurova University Ophthalmology Department based on ocular surface symptoms and CCh detected in ocular examination. Amniotic membrane was applied after conjunctival excision as surgical treatment. The control group was formed with five eyes of five patients who are similar in terms of age and gender distribution with our study group. Tissue samples obtained from the study and control groups were investigated with light and electron microscopy.
Results of pathological examination of conjunctival tissues revealed increased inflammation in 13 patients (68%), lymphatic ectasia in 12 patients (63%), and loss of goblet cells in 17 patients (89%). Destruction of elastic fibers was detected in all cases by staining with elastic van Gieson. After semiquantitative assessment, varying degrees of light microscopic findings were noted considering the localization of CCh. No statistically significant relationship was observed between light microscopic findings and CCh location (p > 0.05 for all). Electron microscopic investigation revealed increase in intercellular spaces, increased cytoplasmic electron density, and the presence of slight vacuolization in cell cytoplasm, and heterochromatin clumping in nuclei of cells in conjunctival samples.
Mechanical and inflammatory factors induce development of CCh, and signs associated with these factors can be detected with light and electron microscopy of conjunctival tissue. No relationship was observed between CCh localization and pathological changes in tissues examined in our study, and large-scale case series are required to evaluate the possible effect of CCh localization on pathological findings.
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7. Surv Ophthalmol. 2018 Jul – Aug;63(4):554-564. doi: 10.1016/j.survophthal.2017.10.010. Epub 2017 Nov. Conjunctivochalasis: a systematic review.
8. J. Murube