EyeWorld Asia-Pacific September 2021 Issue

CORNEA EWAP SEPTEMBER 2021 43 “Often patients can point with one finger where it hurts. o "f course, that can be a number of different things, but when you see that, you have to pay attention. They’ll often report it when they blink,” he said. Dr. Hovanesian described his “thumb test” where he’ll put his thumb on the patient’s lower eyelid below the lashes in the area where they’re reporting pain and ask them to look around. If they say that’s producing pain, it’s a clue into conjunctivochalasis. Clifford Salinger, MD, said that yuorescein stain and a yellow filter are his most helpful tools in visualizing the rugae and redundant conjunctival folds, and punctate conjunctival staining, which he thinks are the causes of many of the symptoms associated with this condition. Dr. Salinger described conjunctivochalasis as a form of “mechanical dry eye” where the normal position of the inferior tear meniscus is blocked by the redundant conjunctival folds, and the tear reservoir in the inferior cul-de-sac is also compromised by the presence of loose Tenon’s fascia and redundant conjunctiva. Without an area for the tear meniscus and tear reservoir to reside, there is not enough reserve tears and lubricants for the eyelid to pull up over and across the eye with each complete blink, thus contributing to the dry eye condition. Medical management Dr. Holland said unless the conjunctivochalasis is severe and very symptomatic, he recommends treating other common ocular surface disease issues first because almost all of his patients with conjunctivochalasis have some degree of MGD. º7hat find is when manage their MGD, a lot of their symptoms go away, and we don’t surgically manage their conjunctivochalasis in many cases. On the other hand, a lot of patients have been on dry eye therapy for years and they’re not happy, and when finally surgically manage their conjunctivochalasis, their symptoms vastly improve,” he said. r. oÛanesian said his first line of defense is lubrication, followed by optimizing any dry eye conditions that can coexist with conjunctivochalasis. He said he’s had limited success with nonsteroidals, Prolensa (bromfenac, Bausch + Lomb) in particular. Dr. Salinger explains to each patient the diagnosis at the outset, using pictures of their own eye to help the patient visualize the problem. While surgical options are not primary treatment, he at least informs the patient of the potential for future surgery to mitigate symptoms. is first step in treating conjunctivochalasis is educating the patient, teaching them about environmental triggers to avoid, addressing inyammation and any meibomian gland dysfunction/ blepharitis. For inyammation, Dr. Salinger said he prefers loteprednol products, and for MGD he recommends hot compresses, lid massage, gentle lid cleaning, adding Avenova (hypochlorous acid, NovaBay Pharmaceuticals) when indicated, HydroEye (ScienceBased Health), an omega-3/omega-6 supplement, azithromycin or doxycycline either topically or systemically, and/or LipiFlow (Johnson & Johnson Vision). If symptoms are not improved with these treatments by the Conjunctivochalasis. Source: Edward Holland, MD