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Conjunctivochalasis is a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eyelid margin.^[1]

Symptoms and diagnosis

Symptoms range from dry eye, epiphora, and irritation, to localized pain, foreign body sensation, subconjunctival hemorrhage, and ulceration. Symptoms are often made worse by vigorous blinking. Diagnosis can be made under a slit lamp upon the observation of redundant conjunctival folds. These folds can be made more apparent by staining with fluorescin dye and by applying gentle upward pressure with a finger to the eyeball through the lower lid. A tear-clearance test can also detect irregularities in the tear-film.^[2]

Causes

Most conjunctivochalasis is thought to be caused by both a gradual thinning and stretching of the conjunctiva that accompanies age and a loss of adhesion between the conjunctiva and underlying sclera related from the dissolution of Tenon's capsule. The resulting loose, excess conjunctiva may mechanically irritate the eye and disrupt the tear film and its outflow, leading to dry eye and excess tearing.^[3] A correlation may also exist between inflammation in the eye and conjunctivochalasis; though it is unclear if this correlation is causal.^[4]^[5] Conjunctivochalasis may be associated with previous surgery, Blepharitis, Meibomian Gland Disorder (MGD), and Aqueous Tear Deficiency,

Diagnosis

Because the disorder often occurs in people with typical dry eye symptoms, it can be difficult to distinguish readily the discomfort caused by the dry eye from that directly related to the redundant conjunctiva.

Treatment

Mild conjunctivochalasis can be asymptomatic and in such cases does not require treatment. Lubricating eye drops can be tried but do not often work.^[6]

If discomfort persists after standard dry eye treatment and anti-inflammatory therapy, surgery can be undertaken to remove the conjunctival folds and restore a smooth tear film. This conjunctivoplasty surgery to correct conjunctivochalasis typically involves resection of an ellipse-shaped segment of conjunctiva just inferior to the lower lid margin, and is usually followed either by suturing or amniotic membrane graft transplantation to close the wound.^[7]

References

^ Hughes WL. Conjunctivochalasis. American Journal of Ophthalmology 1942;25:48-51
^ [ Bruce A. , Loughnan M.(2003) Anterior Eye and Therapeutics A-Z. Elsevier Health Sciences.]
^ Liu D. The separation of the conjunctiva can also be caused by sensitivity to chemicals suspended in the air, or to direct contact with chemicals. The reaction (in appearance) is similar to a chemical burn to the skin. Fluid builds between the conjunctiva and cornea as what appears as a blister, that looks (from a distance) like a liquid tear. Closer examination reveals the bulging conjunctiva. The stretching of the conjunctiva will remain permanent. Conjunctivochalasis A cause of Tearing and Its Management. Ophthalmic Plastic and Reconstructive Surgery 1986;2:25-28
^ Fodor E, Barabino S, Montaldo E, Mingari MC, Rolando M. Qualitative evaluation of ocular surface inflammation in patients with conjunctivochalasisCurr Eye Res. 2010 Aug;35(8):665-9
^ Erdogan-Poyraz C, Mocan MC, Bozkurt B, Gariboglu S, Irkec M, Orhan M. Elevated tear Interleukin-6 and Interleukin-8 in patients with Conjunctivochalasis Cornea. 2009 Feb;28(2):189-93.
^ Meller, D; Tseng, SC (1998). "Conjunctivochalasis: literature review and possible pathophysiology.". Survey of ophthalmology 43 (3): 225–32. PMID 9862310.
^ Bosniak SL, Smith BC. Conjunctivochalasis. Advanced Ophthalmic Plastics and Reconstructive Surgery 1984;3:153-155

חלזיס

English Journal

New method for evaluation of early phase tear clearance by anterior segment optical coherence tomography.

Zheng X, Kamao T, Yamaguchi M, Sakane Y, Goto T, Inoue Y, Shiraishi A, Ohashi Y.SourceDepartment of Ophthalmology, Ehime University School of Medicine, Toon City, Ehime, Japan.
Acta ophthalmologica.Acta Ophthalmol.2013 Sep 11. doi: 10.1111/aos.12260. [Epub ahead of print]
PURPOSE: To describe a new method of measuring early phase tear clearance by anterior segment optical coherence tomography (AS-OCT).METHODS: Sixty normal subjects were divided into a young group (30 subjects; 29.6 ± 7.2 years) and an elder group (30 subjects; 71.4 ± 10.8 years). AS-OCT (CASI
PMID 24020793

Comparison study of two diagnostic and grading systems for conjunctivochalasis.

Zhang XR, Zou HD, Li QS, Zhou HM, Liu B, Han ZM, Xiang MH, Zhang ZY, Wang HM.SourceDepartment of Ophthalmology, Putuo Hospital, Shanghai Traditional Medicine University, Shanghai 200062, China; Department of Ophthalmology, Liqun Hospital, Shanghai 200333, China.
Chinese medical journal.Chin Med J (Engl).2013 Aug;126(16):3118-23.
BACKGROUND: Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies. This study aimed to investigate the disparity between 4-level system cited from Meller and Tseng in 1998 (abbreviated here
PMID 23981623

Japanese Journal

結膜弛緩症手術

横井則彦
あたらしい眼科 = Journal of the eye 29(7), 919-925, 2012-07-30
NAID 10030949652

結膜弛緩症手術 (特集眼科小手術Pearls and Pitfalls)

横井則彦
あたらしい眼科 29(7), 919-925, 2012-07-00
NAID 40019392155

Related Pictures

Conjunctivochalasis-Related Dry Eye Conjunctivochalasis. Ophthalmology Grand Rounds EyeWorld | Overlooked conjunctival illness Conjunctivochalasis | Handbook of Ocular Disease Management Conjunctivochalasis - Wikipedia

★リンクテーブル★

リンク元	「結膜炎」「結膜弛緩症」

「結膜炎」

Conjunctivochalasis
	An eye with conjunctivochalasis.
Classification and external resources
Specialty	ophthalmology
ICD-10	H11.82
ICD-9-CM	372.81

　　[★]

英: conjunctivitis
関: 結膜

see. マイナーエマージェンシー第1版 p.65 SOP.174

概念

結膜に起こる炎症疾患の総称。

病原体と特徴

ウイルス性結膜炎

病原体：アデノウイルス、エンテロウイルス、単純ヘルペスウイルス、インフルエンザウイルス、水痘・帯状疱疹ウイルス、風疹ウイルス、麻疹ウイルス、EBウイルス。
治療法：対症療法。単純ヘルペスに対してはアシクロビル眼軟膏。
症状：透明な滲出液、耳介前リンパ節腫脹、結膜濾胞

細菌性結膜炎

症状：黄白色の眼脂、軽度疼痛

結膜炎をきたす疾患

SOP.175

	疾患名			病原体	潜伏期	病型	症状、経過
感染性結膜炎	流行性角結膜炎	epidemic keratoconjunctivitis	はやりめ	アデノウイルス8,19,37型(ときに4型)	7-14日	急性濾胞性結膜炎	眼脂、流涙、羞明。眼瞼腫瘤、結膜充血、浮腫、結膜の小出血斑。耳前リンパ節の腫脹と圧痛。2-4週間で消退。発症後10日後に角膜に点状上皮化混濁。
	咽頭結膜熱	pharyngoconjunctival fever	プール熱	アデノウイルス3型(ときに4,7型)	5-6日	急性結膜炎	急性結膜炎、咽頭炎、発熱。点状上皮化混濁は少ない。
	急性出血性結膜炎	acute hemorrhagic conjunctivitis		エンテロウイルス70型	1日	球結膜下出血。眼球は浮腫状、結膜充血、濾胞形成は軽度。耳前リンパ節腫脹軽度。発症より3-4日にびまん性の多発性びらん。眼痛、異物感、羞明。約1週間で治癒。罹患後2,3週間後に四肢の弛緩性の運動麻痺や脳神経麻痺があり得る。
	トラコーマ	trachoma
	封入体結膜炎	inclusion conjunctivitis
	新生児封入体結膜炎	neonatal inclusion conjunctivitis
	細菌性結膜炎	bacterial conjunctivitis
	淋菌性結膜炎	gonococcal conjunctivitis
	新生児膿漏眼	blennorrhea of the newborn
アレルギー性結膜疾患	アレルギー性結膜炎	allergic conjunctivitis
アレルギー性結膜疾患	春季カタル	vernal conjunctivitis
その他の結膜炎	フリクテン性結膜炎	phlyctenular conjunctivitis	束状結膜炎
	慢性濾胞性結膜炎	chronic follicular conjunctivitis
	Stevens-Johnson症候群	Stevens-Johnson syndrome
	眼類天疱瘡	ocular pemphigoid
	結膜弛緩症	conjunctivochalasis

「結膜弛緩症」

　　[★]

英: conjunctivochalasis
関: 結膜炎

[1] Hughes WL. Conjunctivochalasis. American Journal of Ophthalmology 1942;25:48-51

[2] [ Bruce A. , Loughnan M.(2003) Anterior Eye and Therapeutics A-Z. Elsevier Health Sciences.]

[3] Liu D. The separation of the conjunctiva can also be caused by sensitivity to chemicals suspended in the air, or to direct contact with chemicals. The reaction (in appearance) is similar to a chemical burn to the skin. Fluid builds between the conjunctiva and cornea as what appears as a blister, that looks (from a distance) like a liquid tear. Closer examination reveals the bulging conjunctiva. The stretching of the conjunctiva will remain permanent. Conjunctivochalasis A cause of Tearing and Its Management. Ophthalmic Plastic and Reconstructive Surgery 1986;2:25-28

[4] Fodor E, Barabino S, Montaldo E, Mingari MC, Rolando M. Qualitative evaluation of ocular surface inflammation in patients with conjunctivochalasisCurr Eye Res. 2010 Aug;35(8):665-9

[5] Erdogan-Poyraz C, Mocan MC, Bozkurt B, Gariboglu S, Irkec M, Orhan M. Elevated tear Interleukin-6 and Interleukin-8 in patients with Conjunctivochalasis Cornea. 2009 Feb;28(2):189-93.

[6] Meller, D; Tseng, SC (1998). "Conjunctivochalasis: literature review and possible pathophysiology.". Survey of ophthalmology 43 (3): 225–32. PMID 9862310.

[7] Bosniak SL, Smith BC. Conjunctivochalasis. Advanced Ophthalmic Plastics and Reconstructive Surgery 1984;3:153-155

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conjunctivochalasis