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Feasibility of morphometric analysis of conjunctival blood vessel as an additional diagnostic indicator of health and vascular disease status
  1. Shobhana Sugirthamuthu1,
  2. Sandhya Sundaram2,
  3. Radha Annamalai3,
  4. Suhas Prabhakar3,
  5. Neha Arora3,
  6. Arthi Mohanendran2,
  7. Parikumar Periasamy4
  1. 1 Department of Ophthalmology, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India
  2. 2 Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
  3. 3 Department of Ophthalmology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
  4. 4 Consultant Ophthalmologist, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India
  1. Correspondence to Dr Shobhana Sugirthamuthu, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India; shobhana{at}

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What are the new findings?

  • This study investigates the diagnostic yield of biopsy of conjunctival vasculature as a novel feasibility study.

  • Conjunctival biopsy is a novel method for the definitive diagnosis of vascular health and disease state because of its easy availability and accessibility.

  • Through histopathology and immune staining of the vessel wall, valuable information is obtained regarding vascular cell health and endothelial function.

How might it impact on healthcare in the future?

  • By identifying early vascular damage, more stringent preventive measures can be applied to patients at high risk of vascular complications.


The conjunctiva is a loose connective tissue that covers the sclera of the eye (bulbar conjunctiva) and inside of the eyelids (palpebral conjunctiva). It serves as a physical barrier, secretes mucin, which forms a part of the tear film, aids the ocular surface to maintain its healthy moisture layer and helps in the defence of the ocular surface.1 The conjunctiva is rich in microvasculature and the bulbar conjunctiva is the only tissue in the human body, where constituent blood vessels are visible as well as are accessible.2 Conjunctival involvement in systemic disease is well known, yet mostly is non-specific and rarely sufficient to make a conclusive primary diagnosis just by direct observation. On the other hand, by being easily obtainable and because they are highly vascular, the conjunctiva may offer the possibility of exploring the underlying systemic or vascular disease, both to diagnose silent disease and as an indicator of prognosis. In addition, the vascular endothelial cell health of the conjunctival vasculature may suitably reflect the vascular health of important organs such as heart or brain. The use of diagnostic excisional conjunctival biopsy is well documented, which can be safely performed as an outpatient procedure.3 The traditional indications for performing conjunctival biopsy include chronic irritation or lesions that may indicate systemic or autoimmune diseases, rarely malignancy. We propose …

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  • Contributors SSug and PP: study conception, design, analysis, manuscript preparation and interpretation of results. SSun, SP, AM, RA and NA: data collection.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.