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Defining the limits of upper and lower conjunctival fornix depths in a healthy Asian Chinese population

Eye volume 39, pages 2289–2297 (2025)Cite this article

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Abstract

Background

The early detection of conjunctival fornix shortening is essential for the effective management of progressive cicatrising conjunctival diseases. Establishing a baseline reference for conjunctival scarring by determining the normative conjunctival fornix depths (FDs) allows for the measurement and monitoring of changes in the conjunctiva. This study explored anatomical variations in conjunctival FDs amongst an Asian Chinese population, providing valuable information for conjunctival fibrosis assessment.

Methods

This retrospective study conducted at a single centre included 295 Chinese individuals (590 eyes) with normal conjunctiva who visited the eye clinic between 2019 and 2023. The lower and upper FDs were assessed using a validated FD measurer (FDM). Mean lower and upper FDs were calculated and stratified by age and gender.

Results

The mean upper and lower conjunctival FDs for the Chinese population in Singapore were 16.1 mm ± 1.6 (95% CI, 15.9–16.2) and 10.1 mm ± 1.7 (95% CI, 10.0–10.3), respectively. Females exhibited shorter FDs (upper 15.7 mm ± 1.5; lower 9.8 mm ± 1.5) compared to males (upper 16.5 mm ± 1.5; lower 10.5 mm ± 1.9) (p < 0.001). Linear regression analysis demonstrated a significant inverse correlation between age and FDs, indicating that FDs decreases with advancing age (R² = 0.1469 for upper and 0.3195 for lower fornices; p < 0.001). Specifically, the mean upper FD ranged from 17.4 mm (95% CI, 17.2–17.7) in the 20–29 age group to 15.2 mm (95% CI, 14.9–15.5) in the 80-89 age group. Similarly, the mean lower FD ranged from 12.0 mm (95% CI, 11.6–12.4) in the 20-29 age group to 8.7 mm (95% CI, 8.5–9.0) in the 80-89 age group. Analysis of the 95% CIs revealed no statistical difference in FD measurements when compared to published Caucasians, South Asians, and Turkish populations.

Conclusions

This study adds to the available literature a set of normative data for upper and lower FD in a Chinese population, highlighting gender-related variations and age-related progressive conjunctival shrinkage. The established dataset serves as a valuable resource for clinicians, enabling them to better manage and monitor patients with conjunctival diseases. These normative values in forniceal depths adds to available data obtained from Caucasian, South Asian, and Turkish eyes. Existing clinical assessment tools incorporating FD measurements, but validated in other ethnic populations, can be used in Chinese populations.

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Fig. 1: Colour photographs illustrating the Fornix Depth measurer used in this study.
Fig. 2: Mean upper and lower fornix depths (FDs) across age groups by gender with 95% confidence intervals (CIs).
Fig. 3: Scatter plots with line of best fit between fornix depth (FD) measurements and age.

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Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. These data are not publicly available due to ethical restrictions and the potential risk of compromising participant confidentiality. All relevant summary data have been presented within the manuscript and supplementary materials, in accordance with Eye’s Data Policy Type 3.

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Acknowledgements

We would like to extend sincere gratitude to Professor John Dart for his invaluable time, expertise, and constructive feedback on this study.

Funding

This work was supported by the following grants held by Hon Shing Ong: SingHealth Foundation Grant, Singapore (Ref: SHF/FG707S/2017), SingHealth Duke-NUS Ophthalmology & Visual Sciences Academic Clinical Programme Award (Ref: 05/FY2019/P1/18-A33), and the National Medical Research Council (NMRC) Transition Award (Ref: MOH-001776). None of the funders had any role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Corneal and External Diseases Department, Singapore National Eye Centre, Singapore, Singapore

    See Teng Tan, Matthew Davidson, Jodhbir S. Mehta & Hon Shing Ong

  2. Singapore Eye Research Institute, Singapore, Singapore

    Hla Myint Htoon

  3. Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

    Saaeha Rauz

  4. Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK

    Saaeha Rauz

  5. Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore

    Jodhbir S. Mehta & Hon Shing Ong

  6. SingHealth Duke-NUS Ophthalmology & Visual Sciences Academic Clinical Programme (ACP), Singapore, Singapore

    Jodhbir S. Mehta & Hon Shing Ong

  7. School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore

    Jodhbir S. Mehta

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  1. See Teng Tan
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  2. Hla Myint Htoon
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  3. Matthew Davidson
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Contributions

Conceptualisation and supervision: HSO, SR, JKD, JSM. Data curation: HSO, MD. Formal analysis, investigation & methodology: STT, HSO, JKD. Funding acquisition: HSO, JSM. Writing draft, review & editing: HSO, STT, SR, JKD, JSM. All authors approved the manuscript.

Corresponding author

Correspondence to Hon Shing Ong.

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Competing interests

Saaeha Rauz is a member of the Eye editorial board. The authors declare that they have no competing interests related to the content of this manuscript. All authors have disclosed any potential conflicts of interest and have adhered to ethical guidelines to ensure the integrity of the research.

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Tan, S.T., Htoon, H.M., Davidson, M. et al. Defining the limits of upper and lower conjunctival fornix depths in a healthy Asian Chinese population. Eye 39, 2289–2297 (2025). https://doi.org/10.1038/s41433-025-03828-9

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