Conjunctivochalasis is a common eye surface condition characterized by the presence of excess folds of the conjunctiva

Conjunctiva

The conjunctiva covers the sclera and lines the inside of the eyelids. It is composed of rare stratified columnar epithelium.-Function:...

 located between the globe of the eye and the eye-lid margin.

Symptoms and Diagnosis

Symptoms range from dry eye

Keratoconjunctivitis sicca

Keratoconjunctivitis sicca , also called keratitis sicca, xerophthalmia or dry eye syndrome is an eye disease caused by eye dryness, which, in turn, is caused by either decreased tear production or increased tear film evaporation. It is found in humans and some animals...

, epiphora, and irritation, to localized pain, foreign body sensation, subconjunctival hemorrhage, and ulceration

Corneal ulcer

A corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats...

. Symptoms are often made worse by vigorous blinking. Diagnosis can be made under a slit lamp upon the observation of redundant conjunctival folds. These folds can made more apparent by staining with fluorescin dye and by applying gentle upward pressure with a finger to the eyeball through the lower lid. A tear-clearance test can also detect irregularities in the tear-film.

Causes and Comorbidities

Most conjunctivochalasis is thought to be caused by both a gradual thinning and stretching of the conjunctiva that accompanies age and a loss of adhesion between the conjunctiva and underlying sclera

Sclera

The sclera , also known as the white or white of the eye, is the opaque , fibrous, protective, outer layer of the eye containing collagen and elastic fiber. In the development of the embryo, the sclera is derived from the neural crest...

 related from the dissolution of Tenon's capsule. The resulting loose, excess conjunctiva may mechanically irritate the eye and disrupt the tear film and its outflow, leading to dry eye and excess tearing. A correlation may also exist between inflammation in the eye and conjunctivochalasis; though it is unclear if this correlation is causal. Conjunctivochalasis may be associated with previous surgery, Blepharitis

Blepharitis

Blepharitis is an ocular condition characterized by chronic inflammation of the eyelid, the severity and time course of which can vary. Onset can be acute, resolving without treatment within 2–4 weeks , but more generally is a long standing inflammation varying in severity...

, Meibomian Gland Disorder (MGD), and Aqueous Tear Deficiency,

Treatment

Mild conjunctivochalasis can be asymptomatic and in such cases does not require treatment. Because the disorder often occurs in patients with typical dry eye symptoms, it can be difficult to readily distinguish discomfort caused by the dry eye from that directly related to the redundant conjunctiva. If discomfort persists after standard dry eye treatment and anti-inflammatory therapy, surgery can be undertaken to remove the conjunctival folds and restore a smooth tear film. This conjunctivoplasty surgery to correct conjunctivochalasis typically involves resection of an elipse-shaped segment of conjunctiva just inferior to the lower lid margin, and is usually followed either by suturing or amniotic membrane graft transplantation to close the wound.