Thermocautery for Inferior Conjunctivochalasis

Nakasato, Satoru; Uemoto, Riyo; Mizuki, Nobuhisa

doi:10.1097/ico.0b013e3181dc81d2

Cited by 30 publications

(20 citation statements)

References 10 publications

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“…The operation time is very short and can be performed in places like outpatient clinics that do not require much equipment [48]. Nakasato S et al showed that thermocautery is a simple and effective treatment for symptomatic inferior CCh [50].…”

Section: Subconjunctivalmentioning

confidence: 99%

Management of Conjunctivochalasis

Doğan

2019

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Conjunctivochalasis is defined as a redundant, nonedematous conjunctiva that causes a wide variety of symptoms. Excess conjunctival tissue may not cause any symptoms and may cause some symptoms like subconjunctival hemorrhage, epiphora, dry eye findings and corneal ulceration. Disturbance of tear meniscus, impaired tear distribution and punctal occlusion play a role in the onset of symptoms. Although the etiopathogenesis of the disease is not yet clearly understood, several theories have been proposed. According to the mechanical theory, age-related mechanical changes in the conjunctiva lead to a chronic obstruction of the lymphatic flow and lymphatic dilatation after this chronic obstruction leads to conjunctivochalasis. According to inflammatory theory, collagenolytic activity increases as a result of inflammation on the ocular surface, causing degeneration of elastic fibers. As a result, degeneration of elastic fibers lead to alterations in the extracellular components of the conjunctival tissue. This inflammatory changes resulting in conjunctival laxity. Although conjunctivosalasis (CCh) is a clinical diagnosis, it is often overlooked by clinicians. CCh patients are can be symptomatic or asymptomatic. Medical and / or surgical treatment is generally needed in symptomatic patients, whereas treatment is not necessary in asymptomatic patients. Medical treatment is the first choice in the treatment of conjunctivochalasis. Artificial tear preparations are widely used in the treatment of CCh due to the deterioration of the tear film layer and dry eye symptoms. In clinical practice, topical anti-inflammatory eye drops are often preferred to reduce ocular surface inflammation. In cases where medical treatment is not sufficient, surgical treatment should be performed. Today, there are many studies showing that surgical treatment is effective in reducing ocular symptoms and ocular surface damage in patients with CCh and in cases with and without dry eye.The surgical treatment plan should include the loose conjunctival tissue located in the lower part, as well as the excess conjunctival tissue located in the nasal and temporal regions and aim to correct the tear meniscus along the entire lower lid margin. The most preferred surgical method is crescent excision of CCh tissue and primary suture of the conjunctiva. Other surgical approaches include fibrin glue and amniotic membrane transplantation and direct scleral suture of CCh tissue. Another surgical method is electrocauterization of the conjunctival tissue. It is applied 5 mm away from limbus and there is no harm to fornixes.

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Section: Subconjunctivalmentioning

confidence: 99%

Management of Conjunctivochalasis

Doğan

2019

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“…Furthermore, it is also supported by the experimental data showing excessive degradation of the extracellular matrix by matrix metalloproteinases (MMPs) under pro-inflammatory cytokines. 26,27 As of now, a number of surgical procedures have been advocated to treat CCh such as scleral fixation suture, 28 crescent bulbar conjunctival excision with direct closure, 6,29 resection combined with inferior peritomy and radial relaxing incisions, 29 excision with AM transplantation, 17,18,30 cauterization/laser coagulation with or without excision 31,32 and subconjunctival fibrin sealant followed by excision. 33 A majority of these procedures focus on elimination of conjunctival folds close to the tear meniscus.…”

Section: Discussionmentioning

confidence: 99%

Restoration of Fornix Tear Reservoir in Conjunctivochalasis With Fornix Reconstruction

Cheng

Yin

Chen

et al. 2016

Cornea

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Purpose To determine whether conjunctivochalasis (CCh) obliterates the fornix tear reservoir and to discern whether there is concomitant aqueous tear deficiency (ATD) dry eye. Methods Retrospective review of 18 eyes of 12 patients with CCh and ATD (CCh+ATD) and 18 eyes of 13 patients with CCh without ATD (CCh-ATD). Changes were compared before and after fornix reconstruction regarding symptoms, basal tear volumes, use of medications, conjunctival inflammation and corneal staining. Results Fornix reconstruction with conjunctival recession and amniotic membrane transplantation (AMT) effectively restored the fornix tear reservoir as evidenced by a significant increase of the basal tear volume in both CCh-ATD and CCh+ATD groups. Multivariate regression analysis confirmed that such improvement was significantly correlated with symptomatic resolution (r = 1, p < 0.001), which was also accompanied by significant resolution of corneal staining, conjunctival inflammation, and reduction of topical medications. Intriguingly, the prior diagnosis of ATD was no longer existent in 10 of the 18 eyes (56%) with CCh+ATD suggesting that ATD could be secondary to obliteration of the fornix tear reservoir by CCh. Conclusion Obliteration of the fornix tear reservoir is a common pathogenic process regardless of whether CCh is associated with ATD dry eye or not. Restoration of the tear reservoir by fornix reconstruction with conjunctival recession and AMT results in significant resolution of symptoms and signs associated with ATD that is secondary to CCh and helps identify genuine ATD dry eye that is independent of CCh.

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“…38,45 Strategies incorporating fibrin glue, suture fixation to the sclera, amniotic membrane placement, and thermal cautery have also been described. 37,40,46,47 The presence of an enlarged caruncle, a megalocaruncle, can be considered a form of CCh, and may cause functional lacrimal drainage obstruction. 48 Anatomically, a megalocaruncle is an enlarged caruncle that extends to or beyond the inferior lacrimal punctum.…”

Section: Blickmentioning

confidence: 99%