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    Understanding the conundrum of conjunctivochalasis

    With an aging patient population, ODs will be seeing more of this clinical presentation



    Conjunctivochalasis is an extraordinarily common, normal variant of the aging process until the patient becomes symptomatic. An amalgamation of complaints tend to be heard:

    • Chronic dryness

    • Redness

    • Foreign body sensation

    • Epiphora

    • Burning

    • Irritation

    • Tired eyes

    Up to 50 percent of individuals may report some or many of those symptoms.6 Some may report that the dryness is worsened by downgaze and frequent blinking.2

    From a visual standpoint, patients may also describe intermittent bouts of blurry vision, which may or may not be worsened by contact lens wear or while reading.1

    Irritation and visual complaints that worsens with soft contact lens wear may be a frequent complaint because it has been found that contact lenses can cause chronic conjunctival inflammation via hypoxia and mechanical trauma, which may exacerbate existing chalasis or in itself may result in stimulating conjunctivochalasis.7

    The chalasis itself can impinge on the contact lens and fold over its edges to create friction and induce a tighter fit to the lens (Figure 2). Patients may complain of fluctuating vision with contact lenses and difficulty removing them at the end of the day.

    Related: The role of lid hygiene in ocular surface disease


    Conjunctivochalasis’s true underlying causative mechanism is unknown, though with recent advances in molecular biology, there is a growing literature that indicates that conjunctivochalasis may result from either age-related connective tissue degeneration or from chronic inflammation.8

    Age-related connective tissue degradation of elastic fibers secondary to cumulative mechanical force from the eyelids onto the conjunctiva has been the predominating theory used to explain conjunctivochalasis’ pathophysiology.9 This theory indicates that repeated mechanical insult from the eyelids cause conjunctival elastic fibers to degrade over time, which result in the bulbar conjunctiva releasing from the sclera and causing the characteristic folds we see with conjunctivochalasis.10

    The aging/mechanical insult theory is supported by work from Mimura and colleagues who found that contact lens wearers were more likely to have conjunctivochalasis than noncontact lens wearers. They also found that conjunctivochalasis was accentuated by more years of contact lens use and by wearing gas permeable contact lenses as compared to soft contact lenses.7

    Alternatively, repeated mechanical insult may be activating inflammatory breakdown of conjunctival connective tissue, which could result in conjunctivochalasis.11 Meller and Tseng originally championed inflammation’s involvement in conjunctivochalasis.8

    Their theory proposed that conjunctivochalasis likely resulted from underlying chronic inflammation that stemmed from decreased tear clearance, which allowed allow degradation enzymes to build up on the ocular surface and subsequently causing the enzymic break down of conjunctival connective tissue over time.12

    Meller and Tseng’s theory has been supported by recent research.1Specifically, there is evidence that stress on the ocular surface caused by ultraviolet radiations, oxidative stress, dry eye, or mechanical trauma causes increased production of inflammatory molecules.9

    Marta C. Fabrykowski, OD, FAAO
    Dr. Fabrykowski received her Doctor of Optometry in 2011 from The Ohio State University College of Optometry. She completed a residency ...


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    Optometry Times A/V