Online Photo Diagnosis
By William Townsend, OD, FAAO
This individual has conjunctivochalasis, a common anterior segment condition that is characterized by one or more redundant conjunctival folds that are parallel to the eyelids and situated between the globe and the lower eyelid. Elschnig and others described this condition as early as 1908, but the term conjunctivochalasis was first used by Hughes in 1942 when he reported that patients who have this condition often report sharp, intermittent pain that occurs primarily on down gaze. It differs from chemosis in that it does not spontaneously resolve.1 Yokoi et al reported that the most common symptoms and signs associated with conjunctivochalasis were irritation, lacrimation, blurred vision, ocular fatigue, discharge, dryness, and subconjunctival hemorrhage.2
Figure 1. Conjunctivochalasis—note the large conjunctival folds parallel to the lid margins.
The pathogenesis of conjunctivochalasis is not completely understood; Meller and Tseng suggested that it is linked to inflammation and collagenolytic activity.1 Mimura and coworkers reported that the prevalence of conjunctivochalasis increases with age.3 Li and coworkers identified over-expression of MMP-1 and MMP-3 in the conjunctiva of individuals who have conjunctivochalasis.4
Asymptomatic conjunctivochalasis requires no treatment, but individuals who experience pain, irritation, ulceration, or subconjunctival hemorrhage may benefit from tear substitutes, lubricants, and corticosteroid drops.1 Severe cases may require surgical intervention; the traditional approach has been conjunctival resection,5 but amniotic membrane transplantation has gained popularity as an alternative procedure.6
Please click this link Video 1. The conjunctival fold moves easily with the blink. Note that when the pressure of the lower eyelid against the globe is eliminated, the folds disappear.
1. Meller D, Tseng SC. Conjunctivochalasis: literature review and possible pathophysiology. Surv Ophthalmol. 1998 Nov-Dec;43(3):225-32.
2. Yokoi N, Komuro A, Nishii M, Inagaki K, Tanioka H, Kawasaki S, Kinoshita S. Clinical impact of conjunctivochalasis on the ocular surface. Cornea. 2005 Nov;24(8 Suppl):S24-S31.
3. Mimura T, Yamagami S, Usui T, Funatsu H, Mimura Y, Noma H, Honda N, Amano S. Changes of conjunctivochalasis with age in a hospital-based study. Am J Ophthalmol. 2009 Jan;147(1):171-177.e1
4. Li DQ, Meller D, Liu Y, Tseng SC. Overexpression of MMP-1 and MMP-3 by cultured conjunctivochalasis fibroblasts. Invest Ophthalmol Vis Sci. 2000 Feb;41(2):404-10.
5. Yokoi N, Inatomi T, Kinoshita S. Surgery of the conjunctiva. Dev Ophthalmol. 2008;41:138-58.
6. Kheirkhah A, Casas V, Blanco G, Li W, Hayashida Y, Chen YT, Tseng SC. Amniotic membrane transplantation with fibrin glue for conjunctivochalasis. Am J Ophthalmol. 2007 Aug;144(2):311-3.