The pathogenesis has not been established but may be similar to that of SLK (see the section Superior Limbic Keratoconjunctivitis). Histologic studies have revealed elastosis and chronic nongranulomatous inflammation. In addition, collagenolysis may explain the conjunctival laxity.
Figure 4-4 “Redundant” conjunctiva of conjunctivochalasis.
(Courtesy of Cornea Service, Paulista School of Medicine, Federal University of São Paulo.)
Patients typically present with chronic ocular irritation that does not respond to treatment with topical lubricants or topical corticosteroid. They may also present with epiphora. In addition to the conjunctival folds on the eyelid margin, punctate staining may be observed. This surface disruption is presumably caused by conjunctival tissue chafing against itself with movement of the eye. These patients may be predisposed to recurrent subconjunctival hemorrhages. A grading system has been proposed (see Meller and Tseng reference) that may help characterize the findings in this underrecognized condition.
It is reasonable to try topical lubricants, antihistamines, a short course of topical corticosteroid, or nocturnal patching. Cauterization of the redundant folds is sometimes effective. Alternatively, the clinician may consider excision of excess conjunctival tissue with primary closure to relieve the chronic ocular irritation and, in some cases, the epiphora. Tissue adhesive may facilitate wound closure without the need for sutures. Amniotic tissue grafting and conjunctival fixation are alternative surgical procedures. See Chapter 13 for further discussion of surgical management.
Meller D, Tseng SCG. Conjunctivochalasis: literature review and possible pathophysiology. Surv Ophthalmol. 1998;43(3):225–232.
Yamamoto Y, Yokoi N, Ogata M, et al. Correlation between recurrent subconjunctival hemorrhages and conjunctivochalasis by clinical profile and successful surgical outcome. Eye Contact Lens. 2015;41(6):367–372.
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.