Management of Conjunctivochalasis

Abstract

Conjunctivochalasis is defined as a redundant, nonedematous conjunctiva that causes a wide variety of symptoms. Excess conjunctival tissue may not cause any symptoms and may cause some symptoms like subconjunctival hemorrhage, epiphora, dry eye findings and corneal ulceration. Disturbance of tear meniscus, impaired tear distribution and punctal occlusion play a role in the onset of symptoms. Although the etiopathogenesis of the disease is not yet clearly understood, several theories have been proposed. According to the mechanical theory, age-related mechanical changes in the conjunctiva lead to a chronic obstruction of the lymphatic flow and lymphatic dilatation after this chronic obstruction leads to conjunctivochalasis. According to inflammatory theory, collagenolytic activity increases as a result of inflammation on the ocular surface, causing degeneration of elastic fibers. As a result, degeneration of elastic fibers lead to alterations in the extracellular components of the conjunctival tissue. This inflammatory changes resulting in conjunctival laxity. Although conjunctivosalasis (CCh) is a clinical diagnosis, it is often overlooked by clinicians. CCh patients are can be symptomatic or asymptomatic. Medical and / or surgical treatment is generally needed in symptomatic patients, whereas treatment is not necessary in asymptomatic patients. Medical treatment is the first choice in the treatment of conjunctivochalasis. Artificial tear preparations are widely used in the treatment of CCh due to the deterioration of the tear film layer and dry eye symptoms. In clinical practice, topical anti-inflammatory eye drops are often preferred to reduce ocular surface inflammation. In cases where medical treatment is not sufficient, surgical treatment should be performed. Today, there are many studies showing that surgical treatment is effective in reducing ocular symptoms and ocular surface damage in patients with CCh and in cases with and without dry eye.The surgical treatment plan should include the loose conjunctival tissue located in the lower part, as well as the excess conjunctival tissue located in the nasal and temporal regions  and aim to correct the tear meniscus along the entire lower lid margin. The most preferred surgical method is crescent excision of CCh tissue and primary suture of the conjunctiva. Other surgical approaches include fibrin glue and amniotic membrane transplantation and direct scleral suture of CCh tissue. Another surgical method is electrocauterization of the conjunctival tissue. It is applied 5 mm away from limbus and there is no harm to fornixes.