The Observation Of The Clinical Features And Histopathological Changes Of Conjunctivochalasis

Conjunctivochalasis is result from elevation of the bulbar conjunctiva lying along the lateral or central lower lid margin,and it is very common in the elderly. Its etiopathogenesis and histopathological changes are not clear, and the pathologic grade of conjunctivochalasis is not established. Our study concerned the clinical features and histopathological changes of conjunctivochalasis.1. Materials and methodsThe relevant features of 26 patients (35 eyes) whose conjunctivochalasis were resected were examined. In the control group, tissue was obtained from 20 age- matched patients (32 eyes) who just had routine cataract surgery or vitrectomy. The histopathological changes of the two groups were compared after HE Stains, elastic Van Giescn's Stains, Masson's Stains and Gomori's aldehyde-fuchsin Stains.2.Results(1) 15 male and 11 female conjunctivochalasis patients (35 eyes total), aged from 43~83 years-old and 66.27 years-old in average included 3 clinical grade II eyes(8.58%), 26 clinical grade III eyes(74.28%), and 6 clinical grade IV eyes(17.14%). The familiar symptoms were tears over flows, foreign body sensation, pricking ,and vision degressive in severe cases. There was an isolated bilateral condition in which redundant bulbar conjunctival tissue interposed between the globe and the lower eyelid, and protruded over the lid margin. The lacrimal riuer abnormal was observed after bulbus fluorescein staining.(2)Morphology changes: 33 of 35 patients had arcuation in the conjunctival surface. Most of control group patients had normal conjunctival, and only 3 eyes had low-grade arcuation in the conjunctival surface(P<0.05).(3) Pathologic changes:The pathologic changes in conjunctivochalasis patients were hyperplasia of squamous epithelium with parakeratosis in 32 eyes, different grade pigmentation of basal cell in 23 eyes, hemorrhage and edema of stroma in 15 eyes, lymphocyte and plasmocyte infiltration in 14 eyes. The elastic fiber layer was decreased in 33 eyes and collagen decreased in 32 eyes. 27 of 32 control group patients had no conjunctival variation(P<0.05).4. Pathologic grade: Eifing D E and Zhang Xingru once had done reseach on clinical grade of conjunctivochalasis. We decided the conjunctivochalasis grade according to the pathologic characteristics: Pathologic Grade I: elastic fibers and collagen fibers mild decreased; Pathologic Grade II: elastic fibers and collagen fibers mild decreased, low-grade hyperplasia of squamous epithelium, pigmentation in basal cell;Pathologic Grade III: elastic fibers and collagen fibers moderate decreased, hyperplasia of squamous epithelium and parakeratosis,pigmentation in basal cell, lymphocyte and plasmocyte infiltration; Pathologic Grade IV: elastic fibers and collagen fibers severe decreased, hyperplasia of squamous epithelium and parakeratosis, pigmentation in basal cell, lymphocyte and plasmocyte infiltration, even lymphoid node formation. The blood vessels of proper layer dilated and bleeded, or even had ulcer on the surface of conjunctiva in severe case. If we compared the pathologic grade to the clinical grade, pathologic grade II 5 eyes,pathologic grade III 21 eyes and pathologic grade VI 10 eyes.3. DiscussionConjunctivochalasis is common in elder people. There is no difference between male and female in the incidence. The familiar symptoms are tears overflow, foreign body sensation,pricking, and vision degressive in severe cases. There is an isolated bilateral condition in which redundant bulbar conjunctival tissue interposes between the globe and the lower eyelid, and protrudes over the lid margin. In the experimentation, the lacrimal riuer abnormal was observed after bulbus fluorescein staining.The typical pathologic changes in conjunctivochalasis patients were hyperplasia of squamous epithelium with parakeratosis, different grade pigmentation of basal cell, hemorrhage and edema of stroma, lymphocyte and plasmocyte infiltration. The elastic fiber layer was decreased in conjunctivochalasis patients.The elastic fiber decreased and chronic inflammation infiltration could be considered as the major cause of conjunctiva changes. We could decide the conjunctivochalasis grade according to the pathologic characteristics. Although the pathologic grade and the clinical grade were not completely coincident, the main trend was that: the higher the clinical grade is, the higher the pathologic grade is.Pathologic grade of conjunctivochalasis work in with clinical grade, and contribute to pathological featuresfeater, pathomechanism and prognosis of disease. It is supplementary to the clinical grade.