Clinical Images

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


Schematic demonstration of the fornix tear reservoir obliterated by Conjunctivochalasis and restored by fornix reconstruction with conjunctiva recession and Amniotic Membrane Transplantation.

Ophthalmology Management Podcast: TissueTuck Technique

Listen to the podcast below from Dr. Douglas Devries, O.D., and Dr. Curtis Manning, M.D., of Eye Care Associates of Nevada on how they partner to diagnose and treat MDE to restore the patient’s anatomical tear reservoir, which addresses the underlying cause of mechanically induced dry eye and helps support:

· Efficient replacement of the degenerated Tenon’s fascia and excised conjunctiva
· Restoration of the tear reservoir to a healthy state
· Return of tear flow from fornix to tear meniscus

Case Studies

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).

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.