Conjunctivochalasis in 2011: A typical yet remarkably analyzed condition .

Uploaded on:
A run of the mill case history:. 72 year old female.Longstanding
Slide 1

Conjunctivochalasis in 2011: A typical yet remarkably analyzed condition ASCRS Symposium & Congress - San Diego 2011 Mr J Aboshiha 1 & Mr C Claoué 2 1 - Moorfields Eye Hospital, London, UK. 2 - Queen\'s University Hospital, London, UK The creators have no budgetary enthusiasm for the topic of this e-notice.

Slide 2

A run of the mill case history: 72 year old female. Longstanding "dry eyes," no other visual history. On examination: Redundant folds of conjunctiva reciprocally (second rate top edges). Accentuated by thorough flickering. Intruded on tear meniscus and wrinkled bulbar conjunctiva with fluorescein. Determination?…

Slide 3

… Conjunctivochalasis (CCh) Etymology: conjunctiva + Grk . Chalasis; a releasing. Initially depicted by Hughes in 1942. Likewise noted by Duke-Elder as "conjunctival hyperplasia which may require surgical expulsion or lessening by electrocoagulation." Defined as an excess, free, non-oedematous conjunctiva between the globe and eyelid .

Slide 4

Conjunctivochalasis: Features 1 Tends to be two-sided and pervasive in more seasoned patients . A typical reason for visual surface disturbance yet its clinical centrality is regularly neglected . Generally transient conjunctiva on lower top edge , however can spread (e.g. is prevalent in Superior Limbic Keratoconjunctivitis). Frequently blended (or confounded) with dry eye . CCh is the dominating analysis when dry eye can\'t be overseen by traditional medicines. Has a tendency to be more difficult than dry eye . CCh increments with age . Contact focal point wear additionally is by all accounts a hazard consider for CCh (HCL > SCL) (Mimura et al . 2009).

Slide 5

Conjunctivochalasis: Features 2 Ocular aggravation is brought on by 2 primary components: Unstable tear film Symptoms of dry eye Delayed tear freedom - conjunctival wrinkling misleads the tear stream toward the external corner of the eye: Inflammatory manifestations & epiphora. Keeps the eye from clearing aggravations, and so on from the visual surface. This \'dry eye\' patient may not be a decent contender for punctal plugs. Can be exacerbated by surgery e.g. peribulbar anesthesia. "Benevolent" subconjunctival discharge is frequently because of CCh and conjunctival redness might be mixed up for "conjunctivitis."

Slide 6

Conjunctivochalasis: Etiology Underlying cause is obscure. CCh is not an aftereffect of conjunctival repetition but instead a releasing of Tenon " s layer between the globe and conjunctiva . Non-granulomatous irritation and elastotic degeneration are found in some histopathologic segments. CCh is described by over-articulation of lattice metalloproteinases (Li et al . 2000). This adds to squint related smaller scale injury .

Slide 7

Conjunctivochalasis: Diagnosis 1 Tear lack Dry Eye Table from : Di Pascuale MA, Espana EM, Kawakita T, Tseng SC. 2004. Clinical qualities of conjunctivochalasis with or without watery tear insufficiency. Br J Ophthalmol. 88:388-392.

Slide 8

Conjunctivochalasis: Diagnosis 2 Vigorous flickering and squeezing a finger to the cover against the globe mitigates conjunctival creases (and compounds manifestations). Utilize forceps to raise repetitive conjunctival folds . Wrinkled example & intruded on tear meniscus with fluorescein , and Rose-Bengal recoloring of non - uncovered conjunctiva (c.f. tear inadequacy dry eye).

Slide 9

Conjunctivochalasis: Diagnosis 3 Grading of CCh (Meller & Tseng 1998) : Grade 0 - no steady crease Grade 1 - a solitary, little overlay Grade 2 - at least 2 folds, however not higher than the tear meniscus Grade 3 - various folds and higher than the tear meniscus Also group: the degree of CCh None; 1 or 2 areas (transient, center or nasal); the entire eyelid? the impact of descending look Improved, unaltered or compounded with descending look? the impact of advanced weight Worse or unaltered with computerized weight? Any nearness of shallow punctate keratitis ?

Slide 10

Conjunctivochalasis: Management No treatment is required for asymptomatic CCh. For symptomatic CCh: Tear substitutes/greases Corticosteroid drops Antihistamine drops Patch before rest to lessen nighttime introduction Exclude different reasons for inordinate tearing. Hindrance of the naso-lacrimal framework: syringe and test. In the event that CCh stays symptomatic subsequent to debilitating every single medicinal treatment, continue to surgical treatment by: Simple extraction OR extra recreation with amniotic film Amniotic layers fortify separation and multiplication of conjunctival cells and smother scar development and aggravation.

Slide 11

Surgical outcomes: Conclusion Meller et al (2000): Successful remaking of conjunctival surface after the expulsion of conjunctivochalasis in 46/47 eyes ( 98% ) with determination of visual disturbance . Georgiadis et al (2001): Resolution of side effects in 12/12 patients with perpetual epiphora created by conjunctivochalasis , after expulsion of the overabundance of conjunctiva took after by amniotic film transplantation. Consider CCh as a conclusion, particularly in obstinate instances of \'dry eye.\' Look for its signs and manifestations . On the off chance that preservationist administration flops then surgery appears to offer an effective result by and large.

Slide 12


View more...