title: The impact of nasal conjunctivochalasis on tear functions and ocular surface findings.
abstract: OBJECTIVE
  To investigate the effect of grade 3 nasal conjunctivochalasis (NCCh) on the tear film inflammation, ocular surface findings, and tear function findings.
  
  
  METHODS
  Prospective, observational case series.
  
  
  METHODS
  Eleven eyes with Yokoi grade 3 NCCh in which the chalatic conjunctiva occluded the punctum and 18 eyes without NCCh but with central or temporal conjunctivochalasis, or both, and 16 eyes of healthy controls were recruited prospectively. Enzyme-linked immunosorbent assay for inflammatory tear cytokines, tear film break-up time (BUT), Schirmer I test measurements, and fluorescein and rose bengal vital stainings and impression cytologic and brush cytologic analysis for real-time reverse-transcriptase polymerase chain reaction analysis of MUC5AC messenger ribonucleic acid (mRNA) expression were performed.
  
  
  RESULTS
  Eyes with grade 3 NCCh had significantly delayed tear clearance. All inflammatory cytokines showed higher values in eyes with grade 3 NCCh compared with the eyes without nasal chalasis with a comparably significant elevation in interleukin-1b and tumor necrosis factor alpha levels. The mean rose bengal score in eyes with grade 3 NCCh was significantly higher compared with eyes without nasal chalasis and eyes of controls. The mean goblet cell density was significantly lower in eyes with grade 3 NCCh with downregulation of the relative MUC5AC mRNA expression.
  
  
  CONCLUSIONS
  Inflammation plays an important role in the pathogenesis of conjunctivochalasis and is more pronounced in eyes with nasal chalasis. Pooling of inflammatory cytokines in tears of patients with NCCh associated with delayed tear clearance induces distinct adverse effects that affect the ocular surface health.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Samantha K
authors.initials: SK
authors.lastname: Ward
authors.forename: Igarashi
authors.initials: I
authors.lastname: Ayako
authors.forename: Yiqian
authors.initials: Y
authors.lastname: Hu
authors.forename: Naoko
authors.initials: N
authors.lastname: Okada
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000368:Aged; D002452:Cell Count; D003229:Conjunctival Diseases / Q000145:classification / Q000378:metabolism* / Q000473:pathology; D016207:Cytokines / Q000378:metabolism*; D015536:Down-Regulation; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019793:Fluorescein; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC; D009077:Mucins / Q000096:biosynthesis / Q000235:genetics; D009666:Nose; D011446:Prospective Studies; D012333:RNA, Messenger / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012395:Rose Bengal; D013194:Staining and Labeling / Q000379:methods; D013666:Tears / Q000378:metabolism*
chemical_list: D016207:Cytokines; C524678:MUC5AC protein, human; D055271:Mucin 5AC; D009077:Mucins; D012333:RNA, Messenger; D012395:Rose Bengal; D019793:Fluorescein