Diagnosis & treatments: Conjunctivochalasis, excision and AMT

OSN SuperSite reported from Hawaiian Eye 2010 Dr. Hovanesian's suggestion for identifying conjunctivochalasis as a possible contributor to dry eye pain, with excision and AMT as the proposed treatment. (See article below.)

I have a request for the doctors performing these surgeries on conjunctivochalasis patients whose primary complaints are dry eye symptoms: Contact some of your patients who are 6-12 months or more out from surgery, and have them post on DryEyeTalk (and answer other patients' questions) or have them give me a call. I have heard from a lot of patients who returned to presurgical symptoms within that time period. I have not heard from a lot of success stories. In fact, I can remember at this moment a grand total of one. I shall remain skeptical until I start hearing from all these reportedly happy patients.

The difficulty with the classic patient of the type I hear from all the time, who has severe pain but limited ocular surface signs, is that they may have two or three things going on - some mild lagophthalmos, MGD, maybe conjunctivochalasis - but what is really causing their pain and how do you know? One of those? All of them? None of them - but rather nerve pain ala Perry Rosenthal's theories? It's impossible to tell without treating each problem, and this particular problem requires expensive and invasive treatment. However, I do appreciate that attention needs to be drawn to this as one of the factors that may be causing symptoms.

Test helps identify conjunctivochalasis in stubborn dry eye cases

KOLOA, Hawaii — A simple thumb test may help diagnose conjunctivochalasis in recalcitrant dry eye cases and result in a satisfied patient after surgical treatment, a speaker said here.

"Conjunctival chalasis is very easy to confuse with dry eye, and a simple thumb pressure test helps identify it," John A. Hovanesian, MD, said at Hawaiian Eye 2010.

While applying pressure to the lower outer eyelid with your thumb, have the patient move their eye up and down to identify the area of chemosis, Dr. Hovanesian said.

In a review of cases at his clinic, Dr. Hovanesian found eight patients who had a diagnosis of refractory dry eye who tested positive for conjunctivochalasis. He found that all patients were older than 50 years and had undergone previous ocular surgery. After a positive identification, all patients underwent an excision and amniotic membrane transplant with a fibrin tissue adhesive, and all patients had a complete resolution of symptoms.

"My take-home message today is to consider conjunctivochalasis in recalcitrant cases of 'dry eye,'" he said.