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Clinicopathologic Study of Conjunctivochalasis

Watanabe, Akihide MD*; Yokoi, Norihiko MD, PhD*; Kinoshita, Shigeru MD, PhD*; Hino, Yoko MD; Tsuchihashi, Yasunari MD, PhD

Basic Investigations

Objective: To clarify the structural features of conjunctivochalasis histopathologically.

Methods: A biopsy of redundant conjunctiva from the same anatomic location of 44 eyes with conjunctivochalasis was examined histologically. All patients, 9 men and 35 women, aged 66.6 ± 7.5 years (mean ± SD, 50.87 years), underwent conjunctivoplasty (termed tear meniscus reconstruction).

Results: 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.

Conclusion: 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.

From the Departments of *Ophthalmology and †Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Received for publication July 8, 2003; revision received October 17, 2003; accepted October 21, 2003.

Supported in part by a research grant from the Kyoto Foundation for the Promotion of Medical Science, and the Intramural Research Fund of the Kyoto Prefectural University of Medicine.

Reprints: Norihiko Yokoi, MD, PhD, Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0841, Japan (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.