Does the Conjunctivochalasis Accompanied by Pseudoexfoliation Syndrome Affect the Ocular Surface and Anterior Segment Structures?

Abstract Purpose: Probability of coexistence of conjunctivochalasis and pseudoexfoliation syndrome (PES) in same individual may increase with aging. We investigated effects of conjunctivochalasis accompanied by PES on ocular surface (OS) and anterior segment (AS) structures.Methods: Cases with only conjunctivochalasis were determined as group-1 (n=62), cases with conjunctivochalasis accompanied by PES as group-2 (n=45), and healthy cases as group-3 (n=56). OS and AS parameters of groups were compared.Results: Compared to group-1, group-2 had higher grade-3 conjunctivochalasis (17.7% vs 46.7%, p=0.039), greater mean grade of conjunctivochalasis (MGC) (1.72±0.24 vs 2.29±0.32, p=0.036), higher total conjunctivochalasis score (TCS) (4.27±1.13 vs 6.12±1.35, p=0.025), shorter tear-film break-up time (TBUT) (9.17±2.53 vs 5.41±1.32, p=0.010), greater OS disease index (OSDI)-score (16.28±3.15 vs 27.36±4.12, p=0.037). Compared to group-3, both group-1 and group-2 had shorter TBUT (group 3-1: p=0.004; group 3-2: p<0.001) and greater OSDI score (group 3-1: p=0.042; group 3-2: p=0.019). Schirmer tests, central corneal thicknesses, keratometries, axial lengths, anterior chamber depths and lens thicknesses of groups were similar (p>0.05). In group-1 and group-2, as age increased, both MGC (r=0.349, p=0.043; r=0.403, p=0.022, respectively) and TCS (r=0.322, p=0.046; r=0.372, p=0.031) increased. In group-2, as both MGC and TCS increased, TBUT (r=-0.370, p=0.034; r=-0.401, p=0.025) decreased and OSDI score (r=0.338, p=0.045; r=0.362, p=0.040) increased.Conclusions: To our knowledge, this was the first study comprehensively investigating effects of conjunctivochalasis accompanied by PES on OS and AS structures together. We found that conjunctivochalasis might cause OS disease, while presence of PES in conjunctivochalasis cases might worsen OS disease and conjunctivochalasis findings.