Delayed tear clearance in patients with conjunctivochalasis is associated with punctal occlusion

Purpose: To evaluate the impact of punctal occlusion on ocular tear clearance and occurrence of epiphora in patients with conjunctivochalasis (CCh). Methods: Seventy-five eyes with the diagnosis of CCh were included in the study. CCh was graded on the basis of the extent of inferior lid margin involvement as follows: 1 = one location, 2 = 2 locations, and 3 = whole lid. Patients within the 3 groups were also subdivided on the basis of the presence of punctal occlusion. The presence of epiphora, occlusion of the inferior punctum, and fluorescein clearance test (FCT) results were recorded for every patient. Results: Of the 75 patients, 56 (75%) had epiphora, 47 (63%) had punctal occlusion, and 54 (72%) had delayed FCT. Twenty-two patients had grade 1 CCh, 43 had grade 2 CCh, and 10 had grade 3 CCh. Epiphora was present in 10 (45%) patients with grade 1 CCh, 38 (88%) patients with grade 2 CCh, and 8 (80%) patients with grade 3 CCh. Punctal occlusion and epiphora were observed more frequently in patients with grades 2 and 3 CCh compared with those with grade 1 CCh (Pearson chi(2) test, p < 0.001). There was a strong correlation between delayed FCT and punctal occlusion (Spearman rank correlation analysis, r = 0.808, P < 0.001). Punctal occlusion was also correlated with the presence of epiphora (Spearman rank correlation analysis, r = 0.691, P < 0.001). Conclusions: A significant proportion of patients with CCh are symptomatic beginning with early stages of CCh. There seem to be no significant differences in any of the clinical parameters between patients with grade 2 and grade 3 CCh. Punctal occlusion seems to play an important role in the impairment of ocular tear clearance and the occurrence of epiphora.