Outcomes of conjunctivochalasis treatment after fornix deepening with retractor recession and repositioning

Abstract

Purpose

To evaluate outcomes of fornix deepening with retractor recession and repositioning for conjunctivochalasis (CCh) on improvement of conjunctival folds and ocular surface symptoms, particularly epiphora.

Methods

Retrospective, single-centre, observational case series of patients with refractory CCh who underwent fornix deepening and retractor recession. CCh was graded using the Hoh classification (grades 0 to 3 depending on the number and height of folds). Epiphora, reflex tearing, and dry eye symptoms were assessed using the validated 'TEAR' score pre- and post-CCh correction.

Results

18 eyes of 11 patients with CCh (average age 68, range 46–82 years) were treated with fornix deepening and retractor recession. All had shallow fornices pre-operatively with a mean CCh grade of 1.7 (typically lower than the tear meniscus). Locations of the folds were variable: diffuse/middle (n = 10), nasal (n = 4), and temporal (n = 4). At 15-month mean follow-up, conjunctival redundancy was absent in 17 of 18 eyes postoperatively, resulting in a restored tear meniscus and reservoir. 91% saw a reduction in tearing frequency (T), with 73% gaining ≥ 2-point improvement. Improvements in clinical effects (E) and activity limitation (A) were seen in 82% and 91% of patients, respectively, with 36% and 64% gaining ≥ 2-point improvement. R scores (related to reflex tearing) improved in 73%, with 64% seeing ≥ 2-point gains. (P < 0.05 for all).

Conclusion

Restoration of the tear reservoir by inferior fornix deepening with retractor recession and repositioning can result in improvement of CCh and epiphora.