Conjunctivochalasis (CCH) is a big issue in ocular surface disease (aka dry eye) and often a frequent cause of epiphora. The video snippet shown below is a case where the patient was experiencing significant epiphora from both conjunctivochalasis and benign eyelid cysts that were displacing the tear meniscus onto the lower cheek. A slight twist is that the cysts themselves contributed to the epiphora. High-frequency radiowave electrosurgery using an Ellman was used to shrink the conjunctiva and cysts. The patients’s symptoms resolved nicely after 2 weeks.
Several excellent papers (see below) have been written showing improvement in dry eye symptoms (and epiphora) after shrinking or excising the redundant conjunctiva. I absolutely 100% agree with the theory that the redundant conjunctiva physically blocks (sterically hinders to use a physical chemistry term) the tear meniscus hence preventing appropriate tear coverage onto the cornea and conjunctiva during blinks. In effect, the conjunctiva fills the potential tear meniscus space thus displacing tears (sometimes onto the cheek)and hence creating a micro-environment similar to a patient having scant tears with a low tear volume.
Some authors classify inferior CCH as a friction-related disease (FRD), whereby the eyelid causes blink-related micro trauma thus increasing inflammation and worsening of dry eye. No doubt, micro trauma between the LOWER eyelid and redundant inferior bulbar conjunctiva increase inflammation from lower lid friction. However, it is likely that the disruption of the tear film predominates the adverse effect on the ocular surface. This is in stark contrast to superior limbic keratoconjunctivitis (SLK) (or lid wiper epitheliopathy) where the anatomy of the globe and position of the eyelid is such that there is definite eyelid micro trauma on the superior conjunctiva.
A neat way to classify the extent of conjunctivochalasis is the “lid-parallel-conjunctival-folds scores: (LIPCOFs). In the really great Science paper by Ji, Y.W., Seong, H., Lee, S. et al., they mention that nasal LIPCOF significantly correlated with symptoms and tear volume and central, temporal, and total LIPCOF significantly correlated with meibomian gland loss, meibomian gland disease stage, and lipid layer thickness. They used Ellman high-frequency radiowave surgery with great results.
- Trivli, Alexandra; Dalianis, Georgios; Terzidou, Chryssa. 2018. “A Quick Surgical Treatment of Conjunctivochalasis Using Radiofrequencies” Healthcare 6, no. 1: 14. https://doi.org/10.3390/healthcare6010014
- Ji, Y.W., Seong, H., Lee, S. et al. The correction of conjunctivochalasis using high-frequency radiowave electrosurgery improves dry eye disease. Sci Rep 11, 2551 (2021). https://doi.org/10.1038/s41598-021-82088-5
- Anna Marmalidou, Sotiria Palioura, Reza Dana, Ahmad Kheirkhah,
Medical and surgical management of conjunctivochalasis, The Ocular Surface, Volume 17, Issue 3,
2019, Pages 393-399, ISSN 1542-0124,https://doi.org/10.1016/j.jtos.2019.04.008.