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Therefore, we investigated the correlation between CCh severity and the matrix metalloproteinase-9 (MMP)-9 point-of-care (POC) semi-quantitative test to determine its suitability for diagnosing and evaluating CCh. We conducted a prospective study comprising healthy participants and patients with evaporative dry eyes and CCh. The participants underwent CCh severity, tear break-up time, Schirmer test, ocular staining score, tear meniscus height, and tear MMP-9 evaluations. The MMP-9 test results were classified into negative and weakly, moderately, and strongly positive. We included 108 participants; 54 participants had CCh and 54 did not. The MMP-9 positivity rate was significantly higher for patients with \u2265\u2009CCh grade 2 than those without CCh (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Of the CCh-negative participants, 75.9% were MMP-9-negative, and 24.1% were moderately\/strongly positive. Conversely, 37.0% of CCh-positive patients were MMP-9-negative, and 63.0% were moderately\/strongly positive. Furthermore, MMP-9 positivity significantly differed among the CCh severity groups (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Finally, there was a positive correlation between CCh severity and MMP-9 positivity (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>R<\/jats:italic>\u2009=\u20090.420). The tear MMP-9 positivity correlated with CCh severity. Therefore, the MMP-9 POC test may help diagnose CCh and evaluate its severity after treatment.<\/jats:p>","DOI":"10.1038\/s41598-025-95195-4","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:23:37Z","timestamp":1760361817000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tear matrix metalloproteinase 9 immunoassay positivity reflects the severity of conjunctivochalasis"],"prefix":"10.1038","volume":"15","author":[{"given":"Jiyeon","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Pil","family":"Bang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaekyoung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyu Young","family":"Shim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Hwa","family":"Jun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"95195_CR1","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.survophthal.2017.10.010","volume":"63","author":"A Marmalidou","year":"2018","unstructured":"Marmalidou, A., Kheirkhah, A. & Dana, R. 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