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N. Yokoi, Y. Ohashi, M. Ogata, M. Yamaguchi, Y. Yamamoto, A. Shiraishi, K. Inagaki, S. Kinoshita; Relationship Between Conjunctivochalasis and Idiopathic Subconjunctival Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2626.
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© ARVO (1962-2015); The Authors (2016-present)
Idiopathic subconjunctival hemorrhage (ISCH) is a common ocular manifestation seen in relatively older people but its exact etiology is still unclear. Earlier investigations suggest a possible relationship between conjunctivochalsis (CCh) and ISCH. The present study aims at a detailed understanding of this relationship based on multiple perspectives.
We examined 508 cases of ISCH [240 males (M)/268 females (F), mean age: 58.9 yrs] considering background at the time of ISCH, hemorrhage area, age distribution, and severity of CCh at the lower lid margin based on original grading. Bulbar conjunctiva lag during eye opening was examined by measuring the movement of a conjunctival blood vessel in 100 healthy eyes (45 M/55 F, mean age: 57.5 yrs). Occurrences of ISCH before and after surgery for CCh were compared in 42 eyes of 38 cases (4 M/34 F, mean age: 68.2 yrs) with recurrent ISCH.
SCH was divided into interpalpebral (IP) and marginal (M) types based on their predominant distribution; temporal IP-ISCH (37.5%) occurred most often, followed by nasal IP-ISCH (26.6%) and temporal M-ISCH (15.9%). In 53.6% of the cases, a background presumably related to ISCH was reported and 72.3% of the cases had lifestyle-related factors (staying up late and eye strain from close-proximity work). The prevalence of IP-ISCH showed a typical bell curve peaking at age 60; that of M-ISCH peaked at age 70. Compared to M-ISCH, IP-ISCH is more common in younger people. Occurrence of lower M-ISCH was more strongly correlated (rs=0.467) with CCh grades than IP-ISCH (rs=0.334). Age distribution of IP- ISCH was consistent with that of the conjunctival lag. Surgery for CCh significantly lessened the frequency of ISCH (p<0.0001) and no recurrence was noted in 81.0% of the cases.
We speculate that IP-ISCH and M-ISCH are produced by friction between the lid margin and the bulbar conjunctiva and between the lid margin and CCh at the lower lid margin, respectively.
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