Treatment of Conjunctivochalasis
Conjunctivochalasis is characterized by the presence of redundant conjunctival folds positioned between the globe and the lower eyelid margin (see Chapter 4, Fig 4-4 and discussion of conjunctivochalasis in Chapter 4). Surgical procedures used to treat these redundant folds include superficial cauterization, conjunctival fixation, resection, and amniotic membrane grafting.
A topical anesthetic (eg, proparacaine hydrochloride 0.5%) is administered. The patient is instructed to look upward and remains in this position throughout the procedure. After either topical anesthetic or subconjunctival injection of 0.2 mL of lidocaine 1% with epinephrine is given, the surgeon grasps the redundant conjunctiva 4 mm from the limbus and cauterizes it, starting with low-voltage (power level 0.6) bipolar cauterization and gradually increasing the voltage until the conjunctiva coagulates. Coagulation is considered adequate when the conjunctiva turns white. Coagulation is performed at 5–10 sites in an arc on the inferior bulbar conjunctiva. The slack conjunctiva shrinks and tightens immediately after coagulation.
Nakasato S, Uemoto R, Mizuki N. Thermocautery for inferior conjunctivochalasis. Cornea. 2012;31(5):514–519.
Conjunctival fixation (plication)
The lower bulbar conjunctiva is pulled inferiorly, stretched to flatten, and sutured to the inferior sclera with 3 interrupted 6-0 absorbable sutures using episcleral bites inserted 8–10 mm posterior to the limbus. The resulting fold of bulbar conjunctiva must be well below the eyelid margin to prevent the patient from experiencing a foreign-body sensation after the procedure.
The surgical technique used for resection of the conjunctiva involves a crescent excision of the inferior bulbar conjunctiva 5 mm from the limbus, followed by suture closure. A modified technique to avoid visible scarring or retraction of the inferior conjunctival fornix includes a peritomy made close to the limbus, followed by 2 radial relaxing incisions to excise the redundant conjunctiva. Some surgeons use fibrin glue instead of sutures to close the conjunctival wound.
Amniotic membrane grafting
After excision of the redundant crescent of conjunctiva, an amniotic membrane is fitted to cover the entire defect and placed with the basement membrane surface up to cover the scleral wound. The membrane is secured to the surrounding conjunctival edge with interrupted fine, absorbable, or nylon sutures with episcleral bites. The surgeon must take care to flatten the membrane tightly onto the scleral surface and approximately to or underneath the epithelial edge.
Doss LR, Doss EL, Doss RP. Paste-pinch-cut conjunctivoplasty: subconjunctival fibrin sealant injection in the repair of conjunctivochalasis. Cornea. 2012;31(8):959–962.
Meller D, Maskin SL, Pires RT, Tseng SC. Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments. Cornea. 2000;19(6):796–803.
Otaka I, Kyu N. A new surgical technique for management of conjunctivochalasis. Am J Ophthalmol. 2000;129(3):385–387.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.