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Distinguishing Aqueous Tear Deficiency (ATD) from Conjunctivochalasis
| Symptoms | ATD Dry Eye | Dry Eye Syndrome with MDE |
| Diurnal Variation | Worst in PM | Same throughout the day |
| Increased Pain | Up Gaze | Down Gaze |
| Increased Blinking | Improves | Worsens |
| Vital Staining | Exposure Zone | Non-exposure Zone |
| Punctal Occlusion | Improved | Worsened |
| Corneal Involvement* | Early | Late |
*Many times patients with long-standing Dry Eye may have neurotropic corneas and may be asymptomatic
The Reservoir Restoration Procedure can restore the tear reservoir and ocular surface to its normal state utilizing AmnioGraft, which facilitates the healing process and recovery for your patients.1
Before 
After Schematic demonstration of the fornix tear reservoir obliterated by Conjunctivochalasis and restored by fornix reconstruction with conjunctiva recession and Amniotic Membrane Transplantation.
Case 1
(a) Before 
(b) After Representative surgical outcome. Preoperative (A) and postoperative (B) of representative patient with fornix reconstruction. This patient presented with chronic redness and epiphora due to redundant conjunctival folds interposed between the lid margin, and the eye globe obliterated the tear meniscus (A) and the tear reservoir in the fornix. One month after reservoir restoration by amniotic membrane transplantation, the eye regained a smooth, quiet, and a continuous tear meniscus without epiphora (B).
Case 2
(a) Before 
(b) After Preoperative (A) and postoperative (B) representation of patient (volunteered) with Conjunctivochalsis (CCh). This patient presented with chronic redness and epiphora due to Redundant, loose & non-edematous Bulbar conjunctiva and interrupted tear meniscus (A). After we perform the reservoir restoration procedure using amniotic membrane, the eye went back to normal, clear and quiet like before with no tearing or redness (B).
References:
1. Cheng, A.M., Yin, H.Y., Chen, R., Tighe, S., Sheba, H., Zhao, D., … & Tseng, S.C. (2016). Restoration of fornix reconstruction. Cornea, 35(6), 736.
2. Cheng, A.M., & Tseng, S.C. (2017). Restoration of Fornix Tear Reservoir by Amniotic Membrane Transplantation in Conjunctivochalasis. In Operative Dictations in Ophthalmology (pp. 25-29). Springer, Cham.
3. Osref.org/medical-education-materials/conjunctivochalasis.aspx
