Conjunctivochalasis

11/4/18

Why have I still got gritty, dry, irritated eyes??

You’ve recommended: • lubricants Conjunctivochalasis • lid cares another piece of the ocular • Omega 3 surface puzzle • IPL • Blephasteam Dr Adam Watson Cataract, Refractive, Cornea, Oculoplastic Surgery

What am I missing? Conjunctivochalasis – what is it?

• lax, floppy conjunctiva lax conjunctiva forming folds • folds along lower eyelid margin • loss of elasticity • commonest inferior, temporal • inflammatory cytokines • increased osmolarity • impairment tear drainage

Dr Adam Watson [email protected] Conjunctivochalasis - why

• loss of elasticity with age • mechanical forces – friction • inflammation1

Retrato de Cornelius van der Geest - Anthony van Dyck , 1620

ARCH SOC ESP OFTALMOL. 2012;87(7):228–229 1. Wang et al. AJO 2008; 144:930-7

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Conjunctivochalasis – specific symptoms Conjunctivochalasis – specific symptoms

• irritation Le et al conjunctivochalasis vs. • burning, FB sensation “simple” dry eye vs control • watering • more symptoms nasal and • similar to dry eye, but central chalasis – may be worse with • chalasis folds higher than blinking, eye closure tear meniscus • tear drainage occlusion • disruption meniscus, tearflow and wetting may result

Le et al. Impact of conjunctivochalasis. PLoS One. 2014;9:e110821

Conjunctivochalasis - grading Conjunctivochalasis – what else could it be?

A. no persistent fold B. single, small fold C. two or more folds, not higher than tear meniscus • post-operative D. multiple folds higher • allergy than tear meniscus conjunctival oedema • infective • other inflammatory • idiopathic

Mimura et al. AJO 2009;147:171-7

Conjunctivochalasis – what else could it be? Conjunctivochalasis – what else could it be?

lymphoproliferative disorder (lymphoma) conjunctival cyst

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Conjunctivochalasis - treatment Conjunctivochalasis - treatment education Surgical options lubricants • electrocautery • reduce friction • radiowave surgery anti-inflammatory • laser • topical NSAID • excision • steroid • open healing surgery • sutured, glued • amniotic membrane

Conjunctivochalasis - treatment Conjunctivochalasis – treatment outcomes

Conjunctival excision • symptom improvement or resolution 90%1 • improvement in TBUT, OSDI 93%2

1. Wang et al. Eur Rev Med Sci Pharm. 2016;20:3519-22 2. Hara et al. Optom Vis Sci. 2011;88:1112-8

Summary

When evaluating ocular surface pain, dryness, foreign body sensation…

Keep conjunctivochalasis on your radar