Inferior Bulbar Conjunctiva Research Articles

The Effect of Autografts from the Inferior and Superior Bulbar Conjunctiva on the Ocular Surface in Primary Pterygium Surgery: A Cytology Study.

This study aimed to evaluate the effect of using an inferior or superior conjunctival autograft in primary pterygium surgery on the postoperative ocular surface. Forty eyes of 40 patients who underwent pterygium surgery with autograft were included in the study. Cytological cell counts were performed on samples taken from the bulbar conjunctiva by impression cytology before and 1 year after the operation. Schirmer 1 test score, lissamine green conjunctival staining score, tear film break-up time (TBUT), and fluorescein corneal staining scores were evaluated. The pain levels of the patients were evaluated with visual analog scale at postoperative 1 day and 1 week. Corneal and conjunctival staining, TBUT, and Schirmer test results demonstrated significant improvement in all patient groups after surgery, but there was no difference between groups (p>0.05). In both preoperative and postoperative impression cytology, the number of goblet cells in the inferior bulbar conjunctiva was higher than in the superior bulbar conjunctiva (p<0.001), while there was no such difference in epithelial cell or mucin staining. There were no significant cytological changes postoperatively in either group (p>0.05). Pterygium surgery with autografting improved tear function tests regardless of graft location. Goblet cell count was higher in the inferior bulbar conjunctiva than in the superior bulbar conjunctiva in both postoperative and preoperative impression cytology. However, there was no significant difference in postoperative epithelial and goblet cell counts or mucin staining between the groups before and after surgery. We think that using the inferior bulbar conjunctiva is an appropriate choice in cases where the superior conjunctiva cannot be used as a graft or when future glaucoma surgery is possible.

A rare case of orbital and diffuse conjunctival venous malformation

Cavernous hemangiomas (CH) are slow-flow venous malformations (VMs), not true vascular tumors. Although these are the most common benign orbital tumors in adults, conjunctival VMs are a rarity and account for less than 1% of all conjunctival tumors. We herein report a case of a 25-year-old male patient who presented with a large violaceous mass involving the inferior bulbar conjunctiva that had been present for 10 years. It was painless, progressive, and gradually increased in size over 10 years, and was associated with occasional bleeding. Any syndromic association was ruled out. Contrast-enhanced magnetic resonance imaging (CEMRI) revealed the presence of slow-flow vascular malformations involving the right superior and inferior eyelids with intraconal and extraconal involvement. An incision biopsy and histopathology (H/P) confirmed the diagnosis of formerly-called cavernous hemangioma (slow-flow VMs). The conjunctival mass was further managed by surgical debulking with ocular surface reconstruction, whereas the intraorbital part was kept under observation owing to its small size. The postoperative period was uneventful.

Ocular tuberculosis presenting with a conjunctival granuloma

An 18-year-old female patient was referred with complaints of tearing and redness in the left eye for 3 months after a mild ocular trauma with a turkey feather. She was treated with topical antibiotics and corticosteroids with no improvement. Slit-lamp examination of the left eye showed a vascularized lesion with a polypoidal appearance due to multiple contiguous micronodules on the temporal and inferior bulbar conjunctiva. Results of the anterior and posterior segment examination were unremarkable in both eyes. A biopsy specimen of the conjunctival mass showed multiple tuberculoid granulomas composed of epithelioid histiocytes with associated Langhan's type multinucleate giant cells and a necrotic nodule surrounded by histiocytes and giant cells. The Mantoux test was positive with induration of 15mm. The patient was prescribed antituberculosis therapy. Three months after treatment initiation, the conjunctival lesions had resolved. Mycobacterium tuberculosis should be considered in cases of unilateral chronic recalcitrant conjunctivitis. Biopsy of a conjunctival mass is of utmost importance to establish a definite diagnosis.

Conjunctival Diffuse Large B-cell Lymphoma

Purpose: To report a case of diffuse large B-cell lymphoma of the conjunctival fornix.Case summary: A 49-year-old man visited our clinic with redness and foreign body sensation in the right inferior conjunctival fornix that had begun 20 days previously. The patient had no pain, no fever, weight loss, and no past history of chronic disease. On slit lamp biomicroscopic examination, a large, salmon-colored, raised, well-defined, mass was detected in the inferior bulbar and fornix conjunctiva. We performed excision biopsy. The soft tissue lesion was 17 × 5 × 4 mm in size. Microscopic examination identified an area of small, mature mononuclear lymphocytes and an area of lymphocytes, such as large lymphoblasts with divided nuclei and conspicuous nucleoli. On immunohistochemical staining, the diffuse large B-cell lymphoma areas were positive for CD20 and Bcl-6, negative for CD3, CD5, and CD23, and the Ki-67 positive rate was relatively high. Finally, the patient was diagnosed with diffuse large B-cell lymphoma accompanying mucosal-associated lymphoid tissue lymphoma. There were no findings suggestive of metastasis invasion from other organs. The patient underwent immunochemotherapy after excisional biopsy. No recurrence has occurred over 1-year follow-up.Conclusions: Although rare, diffuse large B-cell lymphoma should be considered in the differential diagnosis of conjunctival lymphomatous lesions.

Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study.

Purpose:In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening.Methods:40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye.Results:No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection.Conclusion:Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non-ophthalmologic surgeries.

Clinical symptom and sign characteristics of patients with Conjunctivochalasis

Conjunctivochalasis (CCh) is a condition characterized by redundant, loose, and non- edematous conjunctival folds that often located in inferior bulbar conjunctiva. CCh often asymptomatic but also can cause many symptoms. The symptoms of CCh are often connected to delayed tear clearance or tear film instability. CCH is often overlooked in clinical practice; therefore, it is important to recognize this condition to differentiate it from chronic eye irritation and epiphora due to other causes. This research is to evaluate the clinical characteristics of patients with Conjunctivochalasis (CCh). A total of 26 people with Conjunctivochalasis were enrolled in this retrospective investigation. The study included 52 eyes from 40 cases. Ages ranged from 46 to 77 years, with a mean age of 64 years. In this study, all CCh sites were found in the inferior conjunctiva and more in the temporal region (75%). The prevalence of CCh was mostly female (88.5%) and occurred in patients with an average age of 647 year. The most common complaints of CCh patients were eye pain (42%) and dryness (38%). Clinical examination results obtained bilateral CCh more than unilateral, which is 53.8%. Severity of first grade CCh was found in 50% of the sample eyes. Schirmer examination results of less than 5 mm and 5-10 mm obtained the same results of 35%. Fluorescein test results were found to be positive in 57.5% of eyes. While the most TBUT results were obtained in less than 5 seconds, which amounted to 67.5%.

Subconjunctival Loa Loa: A case report

Loa loa is a nematode that is highly endemic in the tropical rainforests of Western and Central Africa. It is also known as “African eye worm”. Occasionally the adult parasite is seen in the subcutaneous tissue space of humans and occasionally into the subconjunctival space. Our case is a 29-year-old male presented to the outpatient department with history of swelling, redness and foreign body sensation in the inferior bulbar conjunctiva of his right eye. Slit lamp examination shows, a nodular swelling in the inferior conjunctival space and diagnosed as subconjunctival granulomatous lesion. In the operation theater, the lesion was explored and a live worm was removed from the subconjunctival space. The worm was measured about 3.5 cm in length. The worm was confirmed to be a Loa loa adult specimen. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. Ophthalmologists should be aware of the typical manifestations and possible unusual presentations. An increasing number of subconjunctival Loa loa cases are reported from non-endemic areas are due to increased travel and migration. This report illustrates an unusual ocular disease, which is usually not found outside of Africa, but easily diagnosed and treated.

Evaluation of plasma assisted noninvasive surgery (PANIS) as a new approach for the treatment of conjunctivochalasis; a clinical case series

ABSTRACT Background: Conjunctivochalasis (CCh) is a common bilateral conjunctival condition defined by loose, redundant conjunctival folds, typically in the inferior bulbar conjunctiva. In recent years, various surgical procedures have been proposed to treat the conjunctivochalasis that each has its own limitations. The aim of this study was the evaluation of a quick surgical treatment of CCh using plasma, as a noninvasive procedure, and its effectiveness. Research design and methods: In this study, six patients with grade 3 and 4 CCh were evaluated as non-randomized and non-blinded trial case series. The surgery was performed using plasma spots produced by the white handpiece of the Plexr device at a distance of 4 mm from the inferior limbus. The number and rows of plasma spots were varied depending on the grade of CCh. Results: After surgery, patients were followed-up for 6 months. In all patients, the grade 3 and 4 CCh were decreased to grade 1 and 2, respectively, after one month all treated eyes were normal and no interface complications were observed. Conclusions: Based on the results, it seems that Plasma Assisted Noninvasive Surgery (PANIS) method can be used as a quick and easy method for the treatment of CCh.

Pterygium Surgery with Conjunctival Autograft Fixation Using Bipolar Electrocauterization.

To report a case series of pterygium surgery with conjunctival autograft fixation using bipolar electrocautery. A noncomparative, retrospective, interventional case series of pterygium surgery with follow-up longer than 12 months to assess recurrence and other complication rates. Fifty-six eyes of 37 patients were treated between April 2011 and January 2018, either for primary (n = 53 cases) or recurrent (n = 3 cases) pterygia. After pterygium excision, free conjunctival grafts from the inferior bulbar conjunctiva of the same eye were harvested and fixated with the use of bipolar electrocautery. Recurrence of the pterygium and complications. The mean follow-up was 41 months (range 12 to 81 months). There were no intraoperative complications. Recurrence of the lesion was seen in three eyes (5.36%). There were no other postoperative complications such as graft detachment, or formation of dellen or granulomas. Conjunctival autograft fixation using bipolar electrocautery seems to be a fast, costly and safe procedure that can be applied in most cases of pterygium surgery.

Differences between Inferior and Superior Bulbar Conjunctiva Goblet Cells in Scleral Lens Wearers: A Pilot Study.

Scleral lenses (SLs) rest on the scleroconjunctival region, which could result in a mechanical impact in the bulbar conjunctiva that can hypothetically modify some properties of conjunctival cells. The purpose of this study was to evaluate the differences in goblet cell density (GCD) and mucin cloud amplitude (MCA) between superior and inferior bulbar conjunctiva in SL wearers. A total of 26 eyes wearing SL were randomly selected from 26 subjects (11 females) with different grades of keratoconus enrolled in a prospective clinical series. Superior and inferior conjunctival impression cytologies were performed and therefore analyzed with scanning laser confocal microscopy to evaluate GCD and MCA. All subjects filled out the Ocular Surface Disease Index (OSDI) questionnaire. The mean ± standard deviation OSDI score was 23.62 ± 15.12. Although a higher density of goblet cells was observed in the samples taken in the superior conjunctiva (74.70 ± 57.55 cells/mm) than on the inferior conjunctiva (55.91 ± 34.80 cells/mm), there were no statistically significant differences between them (P = .14, Wilcoxon). Regarding MCA, no differences were found between superior (21.81 ± 3.30 μm) and inferior (20.72 ± 2.95 μm) samples (P = .201, Wilcoxon). No statistically significant differences were found in GCD and MCA regarding the time of SL wear. There were no differences in GCD and MCA in the samples taken in the superior and inferior conjunctival areas. Also, it seems that the SL wearing time does not affect the density and secretion of goblet cells. Prospective studies need to be conducted in larger samples to confirm those outcomes.

Multicentric Squamous Cell Carcinoma with the Involvement of the Ocular Annexes in a Dog

Background: The cutaneous squamous cell carcinoma (cSCC) is considered to be a frequent neoplasm in dogs, however, its origin in ocular annexes, especially in relation to the conjuctival location, is a rare finding in dogs. Therefore, it was aimed to report the occurrence of a multicentric SCC, with the involvement of ocular annexes in a dog, emphasizing its clinical characteristics and histopathological findings.Case: A 6-year-old non-castrated white-coated Pitbull dog was attended, with a history of increased volume and bloody secretion in the left eye, with an evolution of approximately six months. By means of general physical examination, ulcerated lesions in the foreskin and scrotum were found. During the ophthalmologic examination was identified an extensive and irregular exophytic mass, of a reddish color and with a cauliflower-like appearance, located in the inferior bulbar conjunctiva and third eyelid of the left eye, accompanied by a large quantity of piosanguinolenta secretion, mainly during manipulation. Other alterations were observed, such as, meibomitis, conjuctival hyperemia, hypopyon, corneal edema and loss of sight. In the right eye, the only alteration found was conjunctival hyperemia. The hemograma revealed discreet anemia; the serum biochemical profile was inside the normal range and there was no evidence of metastasis in the imaging examinations. The animal was submitted to the incisional biopsy of the lesions for histopathological analysis, which revealed a proliferation of neoplastic epithelial cells, highly pleomorphic, composed of eosinophilic cytoplasm, which varied from scarce to moderate, of indistinct borders, with a large nucleus and loose chromatin and large and evident nucleolus, compatible with SCC, enabling, also, the classification as multicentric due to the multiple localizations. Additionally, associated to the conjunctival tumor, there was necrosis and mixed inflammatory infiltration; in the scrotum and conjunctiva, the cells presented more accentuated pleomorphism, with the presence of dyskeratosis and little formation of keratin pearls; however in the prepuce, there was abundant formation of keratin pearls in the midst of the tumor. In the immunohistochemical analysis, the neoplastic cells demonstrated strong and uniform cytoplasmic immunoreactivity for pancytokeratin. It was recommended the exenteration of the left eye followed by the introduction of acrylic resin intraorbital implant, together with the resection of the neoplasm from the scrotum and foreskin, associated with cryotherapy. However, the owner was reluctant to the proposed treatment and opted for the euthanasia of the animal, not consenting to the performance of the necropsy.Discussion: The etiological factors related to the development of the SCCs, especially concerning those of the ocular and periocular region, in dogs and cats, are still not well defined. However, the overexposure to the ultraviolet radiation has been pointed as the main etiological factor, especially in tropical and high-altitude regions. Indeed, the characteristics of the region in which the animal resided, associated to its way of life and its phenotypical characteristics suggested that the chronic exposure to ultraviolet radiation would be the most plausible cause related to the emergence of the multicentric SCC of this case. Thus, it is suggested that, while the physiopathology of the neoplasm has still yet not been elucidated, it must be avoided that the dogs, with these characteristics, expose themselves too much to solar radiation.

Occupational effect of sugarcane biomass burning on the conjunctival mucin profile of harvest workers and residents of an adjacent town - A Brazilian panel study

Pre-harvest burning of sugarcane fields produces large amounts of air pollutants which are known to cause health problems, including ocular surface abnormalities. In this study, we evaluated the effect of biomass burning on mucus quality and mucin gene expression (MUC1, MUC5AC, MUC16) in the conjunctiva of sugarcane workers (SWs) and residents of an adjacent town (RTs). Impression cytology samples of the inferior tarsal and bulbar conjunctiva of 78 SWs and 32 RTs were collected before (T1) and immediately after (T2) a 6-month harvest period. The neutral, acid and total mucus content of goblet cells was determined by PAS and AB staining. The levels of MUC5AC, MUC1 and MUC16 mRNA in the conjunctiva were measured by real-time PCR. Compared to RTs, SWs had higher levels of bulbar acid mucus and MUC16 mRNA and tarsal MUC5AC mRNA at T2 and lower levels of neutral mucus at T1 and T2. In the SW group, MUC1 mRNA levels were higher at T2 than at T1, but the levels of neutral and acid mucus were similar. In the RT group, acid mucus decreased and neutral mucus increased in the bulbar and tarsal conjunctiva at T2. In conclusion, our findings show that sugarcane harvesting is associated with abnormalities in mucus quality and content and changes in mucin mRNA levels on the ocular surface. This may help explain the ocular inflammatory signs and symptoms observed in subjects exposed to air pollutants and high temperatures from sugarcane biomass burning.

Subconjunctival hemorrhage in Henoch-Schonlein purpura: a case report and literature review

We report a 5-year-old boy who presented with diffuse abdominal pain, non-thrombocytopenic purpuric skin rash, and bilateral multiple foci of subconjunctival hemorrhage in the inferior bulbar conjunctiva. The patient was diagnosed clinically with Henoch-Schonlein purpura (HSP), according to EULAR/PRINTO/PRES criteria. HSP is a leukocytoclastic small vessel vasculitis. Ocular involvement is very rare. Episcleritis, keratitis, uveitis, cystoid macular edema and cotton wool spots, central retinal artery occlusion, anterior ischemic optic neuropathy and subperiosteal hematoma were reported previously. Here, we present a case of bilateral subconjunctival hemorrhage in a child with HSP for the first time in the English literature.

Lower Tear Meniscus Height Measurements Using Keratography and Swept-Source Optical Coherence Tomography and Effect of Fluorescein Instillation Methods

ABSTRACTPurpose: The first aim of this study was to compare inferior tear meniscus height (TMH) measured by keratography and swept-source optical coherence tomography (OCT). Effect of locations of fluorescein instillation and subjects’ subjective sensation, and the TMH results were also investigated.Methods: Forty-one eyes from 41 healthy adults had TMH randomly measured by keratography (K5M, Oculus, Germany) and swept-source OCT (Casia SS-1000, Tomey Corp, Japan) at baseline, followed by touching either the inferior bulbar or inferior palpebral conjunctiva, randomly assigned, with a moistened fluorescein strip. Two-way analysis of variance (ANOVA) was used to compare TMH obtained from the two devices and three measurement conditions. Subjective sensation of conjunctival touch was obtained through a 4-point scale with zero representing no sensation, and one to three representing ocular sensation in an ascending order.Results: Two-way ANOVA revealed no significant difference in TMH between keratography and swept-source OCT (Factor (devices): F = 0.579, p = .451) while there was a significant difference among fluorescein instillations (Factor (conditions): F = 10.146, p < .001). Baseline TMH was around 0.25 mm, and increased to around 0.28 mm after instillation of fluorescein sodium. Ocular sensation was similar between the two conjunctival touch, and TMH was not significantly associated with ocular sensation.Conclusions: Keratography and swept-source OCT provided similar TMH results. Applying fluorescein sodium through moistened fluorescein strip could over-estimate TMH by around 0.03 mm. Applying moistened fluorescein strip at bulbar or palpebral conjunctival led to similar subjective sensations and did not affect TMH measurement.

Outcomes of preoperative intrapterygial injection of mitomycin C for pterygium excision with and without inferior conjunctival flap.

PURPOSE:This study aimed to report the comparison of recurrence rate and complications of intrapterygial injection of mitomycin C (MMC) 1 month before bare sclera excision of pterygium with and without conjunctival flap from the inferior bulbar conjunctiva.METHODS:This prospective interventional study enrolled 60 patients of pterygia from November 2010 to June 2012. All eyes received 0.1 ml (0.02%) of intrapterygial MMC injection 1 month preoperatively. Patients were divided into two groups of 30 each: Group 1 – bare scleral excision (BSE) and Group 2 – BSE with conjunctival flap from the inferior bulbar conjunctiva to cover the bare sclera. Chi-square test, Fisher's exact test, and unpaired t-test were used for statistical analysis.RESULTS:The mean age was 40.6 ± 12.8 years and 36.9 ± 10.9 years in Group 1 and 2, respectively, (P = 0.2329). There were 11 (36.7%) males and 19 (63.3%) females in Group 1 and 7 (23.3%) males and 23 (76.7%) females in Group 2 (P = 0.101). The recurrence rate was 0% in Group 1 and 3.3% (1 eye) in Group 2 (P = 1.00). Postoperatively, scleral whitening occurred in 6 (20%) eyes in Group 1 and none in Group 2 (P = 0.015).CONCLUSION:Both techniques, BSE alone or with conjunctival flap from the inferior bulbar conjunctiva 1 month after intrapterygial MMC, resulted in negligible (0%–3.3%) recurrence of pterygium. Conjunctival flap significantly reduced (0%) the postoperative complication of scleral whitening. This is the first report of efficacy of conjunctival flap in reducing scleral whitening after intrapterygial MMC.

Conjunctival Melanoma in a Horse Treated by Tumor Resection and Cryotherapy

Background: Ocular melanoma is very rare compared to cutaneous melanoma in horses. Definitive diagnosis is made through histopathological examination and treatment options include surgical excision associated with cryotherapy, radiation therapy, and chemotherapy. In this report, we describe a case of conjunctival melanoma in a horse that has been treated successfully with surgical excision associated with cryotherapy.Case: A 15-year-old male Percheron male was referred to the Ophthalmology Veterinary Section of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, with a history of a pigmented mass located on the lower eyelid of the left eye. Ophthalmologic examination revealed ocular discomfort, secretion and a pigmented mass in the left inferior bulbar conjunctiva. The dermatological examination revealed other melanomas in the perineal region. Complete blood count and serum chemistry profile were within normal ranges and prior to surgery the horse was treated with flunixin meglumine (1.1 mg/kg, IV, q 12 h). Sedation was performed with xylazine (0.4 mg/kg, IV) and detomidine hydrochloride(0.01 mg/kg, IV) and then the animal was placed in a retention trunk. The conjunctival mass was resected with a margin of safety. Liquid nitrogen was applied to the tumor site and the adjacent conjunctiva with a copper cryoprobe with one unit of liquid nitrogen. Histopathological examination revealed neoplastic cells containing pigmented melanocytes in the conjunctival submucosa, confirming the diagnosis of conjunctival melanoma. Postoperative treatment was performed with flunixin meglumine (1.1 mg/kg, IV, q 12 h) for 3 days and topical ophthalmic ointment containing neomycin, polymyxin B sulfate and dexamethasone twice daily for one week. Seven days after surgery, the lesion was healed. The patient was followed for 24 months after excision and there was no evidence of recurrence.Discussion: Older horses are considered more predisposed to melanoma development, possibly because of the proliferation of melanocytes as a manifestation of aging, and in addition, cutaneous melanomas are common in gray horses and rare in other horse colors. In this case, the horse was a 15-year-old Percheron horse with gray hair. In horses, there is only one case of conjunctival melanoma documented in the literature. In both cases, the ophthalmic examination revealed a large, raised, heavily pigmented mass protruding from the bulbar conjunctiva. The only difference is that in the present case the location of the mass was in the inferior bulbar conjunctiva and in the case cited in the literature. The mass was located in the bulbar conjunctiva under the lateral comer. In this case, the diagnosis of conjunctive melanoma was based on clinical signs and confirmed by histopathological examination. It was decided to perform an excisional biopsy for treatment and to confirm the diagnosis of conjunctival melanoma. The choice of treatment depends very much on the clinical presentation, that in this animal, despite the neoplasia being extended, it was located only in the conjunctiva without involvement of the sclera and the eyelid. Therefore the decision was made to perform an excisional biopsy associated with cryotherapy. The purpose of such adjuvant therapy is to kill all residual tumor cells and prevent the recurrence of malignant tumors. In the present case, the surgical wound was cured one week after surgery. The surgical procedure in the case reported was performed under local anesthesia and sedation with the horse standing. To make this decision, consideration should be given to patient health, anesthetic risk, and additional risks during recovery from general anesthesia. In this case, surgical excision of the mass associated with cryotherapy was effective in the treatment of conjunctival melanoma in a horse.Keywords: ocular, equine, melanocytic neoplasia, cryosurgery.

A preliminary study on the establishment of an animal model of conjunctivochalasis.

To explore a feasible method on the establishment of an animal model of conjunctivochalasis (CCH). Twelve clean-grade New Zealand white rabbits were divided into four groups (n=3/group): the control group (one received no interventions, and the others underwent subconjunctival injection of sterile water), the matrix metalloproteinases (MMPs) group (administered subconjunctival injection of MMP-3), the aging group (administered subcutaneous injection of D-galactose), the tumor necrosis factor-α (TNF-α) solution group (administered eye drops of TNF-α). Anterior segment photography, conjunctival tissue light microscopy and transmission electron microscopy (TEM) were performed after 12wk. Among all groups, the MMPs group had the following changes: the looser connection between the inferior bulbar conjunctiva and sclera; the more disordered collagen fibers (Trichrome staining) and the broken elastic fibers (Aldehyde-fuchsin staining); the focal necrosis of fibroblasts (TEM). Administration of MMPs may be a feasible method for the establishment of an animal model of CCH.

The Influence of Age and Sex on Ocular Surface Microbiota in Healthy Adults.

A growing body of evidence suggests that the microbiome of the ocular surface confers potent immunoregulatory functions and has a key role in the physiologic maintenance of healthy eyes and in the pathogenesis of ocular diseases. Although the microbiome is known to be affected by age and sex, the influence of these factors on ocular surface microbiota in healthy adults remains largely unknown. Ocular surface microbiome samples were obtained from the inferior bulbar conjunctiva of 48 young and 42 old adults at Zhongshan Ophthalmic Center. Using metagenomic shotgun sequencing, we characterized the sex- and age-differences in conjunctival microbiome profiles of healthy adults. Male and female groups differed only in the β diversity of bacterial communities, while there were significant differences in bacterial composition, metabolic functions, and the abundance of antibiotic resistance genes between young and old adult groups. Our findings suggest that age and sex collectively shape the conjunctival microbiome, and may change the immune homeostasis of the ocular surface through alterations of its commensal microbiome.

Effect of Mandarin Orange Yogurt on Allergic Conjunctivitis Induced by Conjunctival Allergen Challenge.

To evaluate the effects of mandarin orange yogurt containing nobiletin and β-lactoglobulin on the allergic conjunctivitis induced by a conjunctival allergen challenge (CAC). Experiment 1 was performed on 26 asymptomatic patients (age, 25.3 ± 5.3 years) with proven seasonal allergic conjunctivitis due to cedar pollen. We compared the degree of conjunctivitis induced by CAC before and after ingesting mandarin orange yogurt for 2 weeks. Experiment 2 was a double-blind, placebo-controlled trial performed on 31 patients (age, 32.5 ± 12.2 years). A diet containing mandarin orange yogurt was compared to a diet containing yogurt lacking the mandarin orange on the conjunctivitis induced by CAC. The temperature of the inferior bulbar conjunctiva was measured before and 20 minutes after the CAC with an ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was graded by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. In experiment 1, the scores of redness (3.07 ± 3.03 vs. 1.05 ± 1.70), chemosis (2.84 ± 2.27 vs. 0.81 ± 1.11), itching (4.34 ± 3.05 vs. 1.39 ± 2.12), and temperature (0.73 ± 0.42°C vs. 0.45 ± 0.43°C) were significantly lower (P < 0.001) after a diet of mandarin orange yogurt for 2 weeks. In experiment 2, the scores of redness (1.03 ± 0.18 vs. 1.28 ± 0.52; P = 0.0156), itching (1.93 ± 1.92 vs. 2.82 ± 2.21; P = 0.0133), and surface temperature (0.54 ± 0.21°C vs. 0.31 ± 0.25°C; P < 0.001) were significantly lower in the mandarin orange yogurt group than in the control yogurt group. Mandarin orange yogurt can be an effective nutritional intervention for allergic conjunctivitis.

Wies procedure versus Jones procedure in the surgical correction of acquired lower eyelid involutional entropion

Objective The aim of this study was to compare the effect of Wies procedure with that of Jones procedure in the primary repair of lower eyelid involutional entropion. Background Involutional entropion (senile entropion) is a general instability of the lid structures with age with inward rotation of the eyelid margin. The eyelashes rub against the inferior cornea and bulbar conjunctiva causing irritation. This finally leads to impaired optical function of the ocular surface. Different methods have been described aiming at treating one or several of the etiological factors of the involutional entropion. Patients and methods In the current comparative prospective study, 30 patients (31 eyelids) with senile lower eyelid involutional entropion without horizontal eyelid laxity were selected and divided into two groups. Group 'A' included 16 eyelids of 15 patients that were corrected using Wies procedure and group 'B' included 15 eyelids of 15 patients that were corrected using Jones procedure. Results In the group subjected to Wies procedure, during the follow-up period (6 months), 12 (85.7%) cases were successful, two cases were missed from follow-up, and two (14.3%) cases were unsuccessful (undercorrection in one case and recurrence in the other). However, in the group subjected to Jones procedure, 14 (93.3%) cases were successful and only one (6.7%) case was unsuccessful (overcorrection occurred). In the Wies group, nine (64.3%) cases showed cosmetically accepted results and five (35.7%) did not. However, in the Jones group, 12 (80%) cases showed cosmetically accepted results and three (20%) cases did not (P = 0.03). In the Wies group, eight (57.1%) patients were satisfied and six (42.9%) were not. However, in the Jones group, 13 (86.7%) patients were satisfied and two (13.3%) were not (P = 0.55). Conclusion Jones procedure is more likely successful, cosmetically acceptable, and satisfactory to the patients compared with Wies procedure.