I was an early adopter of identifying conjunctivochalasis (CCh) and addressing it as a true pathologic condition from which our patients suffer. Conjunctivochalasis dry eye, as it is often called, is truly a misnomer. While CCh contributes to dry eye symptoms, it is a separate entity from the “standard dry eye” that we see in our practices. Furthermore, a number of myths are associated with CCh.
CCh presents as dissolved and degenerated Tenon’s with excess, loose conjunctiva in the inferior fornix, and fat prolapsed into the inferior cul-desac. This results in both the obliteration of the tear reservoir within the inferior fornix and obstruction of the tear meniscus along the inferior eyelid margin. Normal tear distribution and outow are disrupted, and the patient experiences dry eye symptoms.
When all of the standard remedies for dry eye fail to alleviate the symptoms to the patient’s satisfaction, surgery becomes the appropriate solution. Cautery of the conjunctiva alone does not work. It shrinks the conjunctiva, which is actually already shortened in CCh, and creates an area for the meniscus.
However, it does not address the obliteration of the inferior cul-de-sac, the area of the tear reservoir, the reservoir we do not see. Instead, the Reservoir Restoration Procedure, utilizing AmnioGraft® cryopreserved amniotic membrane, should be performed. AmnioGraft, because of its anti-inammatory, antiscarring properties, promotes healing with superior cosmetic results.
The key steps in Reservoir Restoration Procedure are presented in the Reservoir Restoration Procedure surgical guide. As a procedure capable of adequately addressing the problem that underlies CCh, Reservoir Restoration with AmnioGraft goes a long way toward improved outcomes and building positive patient experiences. My practice benefits as well by an increase in referrals from these happy patients.
Clifford L. Salinger, MD is the medical director of The Dry Eye Spa at VIP Laser Eye Center in Palm Beach Gardens, Fla.s