J Korean Ophthalmol Soc.  2013 Aug;54(8):1165-1174.

Histopathologic Characteristics of Conjunctivochalasis

• Bae JB
• Park WC

Abstract

PURPOSE
In this study we investigated the histopathologic characteristics of conjunctivochalasis and its association with lymphangiectasis using impression cytology and conjunctival excisional biopsy in patients with conjunctivochalasis.
METHODS
This prospective study included 14 outpatients diagnosed with conjunctivochalasis, and who had excisional biopsies performed between March 1, 2012 and November 30, 2012. Preoperative slit-lamp examination, dry eye diagnostic test and impression cytology were also performed. For histological analysis, conjunctival sections were stained with hematoxylin and eosin (H&E), Verhoeff-van Gieson (VVG) elastic staining, and monoclonal antibody D2-40, a lymphatic endothelial marker.
RESULTS
Tear break-up time and Schirmer's value were decreased in patients with conjunctivochalasis. Impression cytology showed a decrease in goblet cell density and an increase in nucleoplasmic/cytoplasmic ratio. The patients' conjunctival tissues exhibited an infiltration increase of chronic inflammatory cells on H&E stain, and a decrease in collagen density with degeneration of elastic fibers on VVG stain compared to tissues from the control subjects. D2-40 immunohistochemistry revealed the dilated subconjunctival lymphatics in patients with conjunctivochalasis.
CONCLUSIONS
This study suggests that the characteristic histopathological features of conjunctivochalasis include dilated lymphatic vessels as well as decreased goblet cell and collagen densities with degeneration of elastic fibers.

Keyword

Conjunctivochalasis; Impression cytology; Lymphangiectasis

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
Biopsy
Collagen
Diagnostic Tests, Routine
Elastic Tissue
Eosine Yellowish-(YS)
Eye
Goblet Cells
Hematoxylin
Humans
Immunohistochemistry
Lymphangiectasis
Lymphatic Vessels
Outpatients
Prospective Studies
Antibodies, Monoclonal, Murine-Derived
Collagen
Eosine Yellowish-(YS)
Hematoxylin

Figure

• 

  Figure 1. Grading of conjunctivochalasis. (A) Grade 0: No persistent fold in control group. (B) Grade 1: Single, small fold. (C) Grade 2: More than two folds and not higher than the tear meniscus. (D) Grade 3: Multiple folds and higher than the tear meniscus.

• 

  Figure 2. Method of impression cytology and biopsy (A and B). Cellulose acetate paper is applied to the in-ferior and superior bulbar conjunctiva using a pair of smooth and flat-ended forceps. (C) Conjunctival biop-sy samples are excised in redundant conjunctiva lo-cated 1 mm apart from the limbus at 3 to 9 o’clock position.

• 

  Figure 3. Impression cytol-ogy shows a marked decrease in goblet cell density and an increase in nucleoplasmic/ cytoplasmic ratio in conjun- ctivochalasis group (B and C) compared with the control group (A). PAS-positive gob-let cells increased at post-operative 3 months in con-junctivochalasis group (D) (Periodic acid Schiff stain, ×200).

• 

  Figure 4. Histologic findings of the conjunctiva in the control (A) and conjunctivochalasis group (B-D). Infiltrating in-flammatory cells are increased in conjunctivochalasis group compared with the control (H & E stain, ×200).

• 

  Figure 5. Elastic degener-ation and collagen density of the conjunctiva (Verhoeff-van Gieson stain, ×200).(A) No fragmentation of elastic fibers and dense colla-gen fibers in control group. (B-D) Fragmentation of elas-tic fibers and sparsely as-sembled collagen fibers. (B) Mild elastic degeneration (Grade 1) and high collagen density (Grade 3). (C) Moderate elastic degeneration (Grade 2) and moderate collagen den-sity (Grade 2). (D) Severe elastic degeneration (Grade 3) and low collagen density (Grade 1).

• 

  Figure 6. Histologic findings of the conjunctiva in D2-40 stain (×200). Conjunctivo- chalasis group (B-D) reveals increased number of lym-phatics and lymphangiectasis compared with the control group (A).

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