Eyeworld

106 | EYEWORLD | JULY 2021 C ORNEA by Liz Hillman Editorial Co-Director About the physicians Neel Desai, MD The Eye Institute of West Florida Tampa, Florida Edward Holland, MD Professor of Ophthalmology University of Cincinnati Cincinnati, Ohio John Hovanesian, MD Jules Stein Institute University of California, Los Angeles Los Angeles, California Clifford Salinger, MD VIP Laser Eye Center Palm Beach Gardens, Florida Tanya Trinh, MBBS, FRANZCO Mosman Eye Centre Sydney Eye Hospital Sydney, Australia Diagnosing conjunctivochalasis Dr. Holland called conjunctivochalasis a diagno- sis of exclusion. "On the initial visit, I do not recommend the definitive treatment for conjunctivochala- sis, which is surgery for most significant cases. What I recommend is to rule out the more com- mon causes of ocular surface symptoms: Does this patient have aqueous tear deficiency? Does this patient have MGD? Any findings of aller- gic conjunctivitis? I will treat those conditions if they're present because patients can have conjunctivochalasis and not have symptoms related to it. If the standard treatment of the common causes of ocular surface disease fail, then I know I have ruled out the more com- mon diagnoses and I can be more certain that conjunctivochalasis is the cause of the patient's Recognizing, understanding, and treating conjunctivochalasis continued on page 108 U nderdiagnosed, often neglected, and much more common than clinicians realize is how some physicians de- scribe conjunctivochalasis. Patients with symptomatic conjunctivochalasis often complain of dry eye and receive treatment that doesn't resolve their symptoms. Often the system ends up pushing these patients to cornea specialists who ulti- mately discover the condition, make the diagno- sis, and determine a course of treatment. "We [need to] start by understanding that this is a significant clinical entity. It's not rare, and it should be in your differential diagnosis of ocular surface disease," said Edward Holland, MD. Tanya Trinh, MBBS, FRANZCO, said a review of conjunctivochalasis concluded that the condition most commonly affects elderly patients, although it can be seen in a wide range of ages. She said its precise prevalence in the U.S. is not known, but some reports have shown higher prevalence in Asian populations. "Not all cases of conjunctivochalasis are clinically significant, and non-standardized diagnostic criteria likely contributes to the wide variance in reported prevalence rates," Dr. Trinh said. "It is also likely underdiagnosed because patients typically will come in presenting with dry eye symptoms and ocular irritation and it is only upon examination and work-up that it is discovered; patients typically are not referred straight in with this diagnosis. Underdiagnosis also occurs because a large proportion of patients with this condition are asymptomatic," Dr. Trinh continued. "If patients are experiencing symptoms, they most often complain of dryness, discomfort, blurred vision, fatigue, pain and burning, foreign body sensa- tion, and episodes of tearing," she said. According to Nambi Nallasamy, MD, who wrote about conjunctivochalasis on the website of the American Academy of Ophthalmology, "no true etiology has been determined" for the condition. 1 He noted several studies that suggest mechanical causes, observe the overexpression of inflammatory metalloproteinases and inflam- matory cytokines, and describe how conjuncti- vochalasis affects tear meniscus formation and blocks tear movement from the fornix. 2–5 Conjunctivochalasis Source: Edward Holland, MD

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