Increasing Prevalence and Severity of Conjunctivochalasis With Aging Detected by Anterior Segment Optical Coherence Tomography KORAY GUMUS AND STEPHEN C. PFLUGFELDER  PURPOSE: To evaluate the impact of aging on conjunc- tivochalasis in an objective manner using anterior seg- ment optical coherence tomography.  DESIGN: Prospective clinical trial.  METHODS: Sixty eyes of 30 healthy volunteers (15 men, 15 women; age range, 24-75 years) without any ophthalmic diseases were recruited for the study. Subjects were organized into 3 sex-matched groups, each including 10 subjects according to their ages: 20-39 years (Group 1), 40-59 years (Group 2), 60-75 years (Group 3). Cross-sectional area of conjunctivochalasis was mea- sured at 3 locations (temporal, central, and nasal) using Fourier-domain optical coherence tomography. Tear meniscus height was also measured in all images where a typical triangular-shaped tear meniscus was obtained.  RESULTS: In terms of the cross-sectional area of con- junctivochalasis, there were statistically significant differ- ences among 3 groups at temporal and nasal locations (P < .001). At the central location, whereas there were no subjects in Groups 1 and 2, solely 3 eyes revealed con- junctivochalasis in Group 3. The severity of conjunctivo- chalasis affecting the temporal and nasal bulbar conjunctiva was strongly correlated with age (h 2 [ 0.81, P < .001 and h 2 [ 0.78, P < .001). Lower cen- tral tear meniscus height was compared among the groups and a significant increase with age was observed (P < .001).  CONCLUSION: Fourier-domain optical coherence tomography provides an objective and quantitative approach for assessing the stages of conjunctivochalasis. The current study objectively confirms that conjunctivo- chalasis can be observed even in younger, healthy eyes; its severity increases with age; and it may alter tear dis- tribution along the lower lid. (Am J Ophthalmol 2013;155:238–242. Ó 2013 by Elsevier Inc. All rights reserved.) C ONJUNCTIVOCHALASIS, WHICH IS CHARACTERIZED by a loose, redundant, nonedematous inferior bul- bar conjunctiva interposed typically between the globe and the lower eyelid, has been reported to be an important cause of ocular discomfort and tear instabil- ity. 1-3 The condition can be localized in the nasal, central, and temporal part of the lower eyelid and usually occurs bilaterally. 1,3 There is no consensus regarding the exact cause and path- ogenesis of conjunctivochalasis. Whereas conjunctivo- chalasis has been reported to be associated with aging and dry eye symptoms, 2-4 ocular surface inflammation has been proposed as one of the most important causative factors by some studies. 3,5,6 However, it is not clear whether ocular surface inflammation causes conjunctivochalasis or vice versa. Coexisting aging confounds the results of studies investigating the clinical impact of conjunctivochalasis on ocular surface health and/or the etiopathogenesis of conjunctivochalasis tear dysfunction or different subjective grading schemes for conjunctivochalasis. Accordingly, the objectives of the current study were to investigate the impact of aging on the formation of conjunctivochalasis in otherwise healthy volunteers without evidence of tear film dysfunction or ocular surface disease in an objective manner using anterior segment optical coherence topography (AS-OCT), and to provide an objective method for grading conjunctivochalasis. METHODS  SUBJECTS: Sixty eyes of 30 healthy volunteers (15 men, 15 women; range, 24-75 years) without complaints of eye irritation were evaluated. Exclusion criteria included dia- betes mellitus; atopic dermatitis; rosacea; history of contact lens wear; use of any topical medications; prior ocular sur- gery or trauma; eyelid abnormalities such as entropion, ectropion, and trichiasis; ocular atopy; anterior blepharitis; and meibomian gland disease beyond normal age-related changes. 7 Subjects were organized into 3 sex-matched groups according to their ages: 20-39 years (Group 1: 10 subjects), 40-59 years (Group 2: 10 subjects), and 60-75 years (Group 3: 10 subjects). Accepted for publication Jul 16, 2012. From the Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Koray Gumus is currently at Erciyes University School of Medicine, Department of Ophthalmology, Kayseri, Turkey. Inquiries to Stephen C. Pflugfelder, Ocular Surface Center, Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin, NC205, Houston, TX 77030; e-mail: stevenp@bcm.tmc.edu 238 0002-9394/09/$36.00 http://dx.doi.org/10.1016/j.ajo.2012.07.014 Ó 2013 BY ELSEVIER INC.ALL RIGHTS RESERVED.