الفهرس | Only 14 pages are availabe for public view |
Abstract Conjunctiva is a translucent mucous membrane which covers the anterior surface of the eyeball and the posterior surface of the eyelids. The term conjunctivochalasis, taken from the Greek term meaning “relaxation of conjunctiva”. Conjunctivochalasis (CCh) is described as a redundant, loose, non-edematous inferior bulbar conjunctiva interposed between the globe and the lower eyelid. The condition tends to be bilateral and can be localized in the medial,central, or lateral part of the lower eyelid, it is not uncommon but often overlooked as a normal ageing variation. The exact underlying cause of conjunctivochalasis is unknown. But it was considered as a senile change. Alternatively,both elastotic changes and collagenolysis might independently contribute to the formation of conjunctivochalasis. The preferential involvement of the inferior bulbar conjunctiva and lid margin strongly suggests that the insult leading to the elaboration of the degrading enzyme is derived from tears accumulated in the inferior fornix and the tear meniscus due to delayed tear clearance which may be linked to inflammation , dry eye, also conjunctival trauma produced by vigorous patient eye rubbing that could cause conjunctivochalasis with an associated inflammatory reaction .It was speculated that conjunctivochalasis may be another cause of delayed tear clearance which in turn causes an increase in collagenolytic activity and establishes a vicious cycle. Classification of CCh which was first based on the number of folds and the height of the redundant conjunctiva with respect to that of the tear meniscus in grades from 0-4 and then was modified to include the extension of conjunctivochalasis and gaze-dependent changes. Digital pressure was included as a factor in estimating the extent of severity. CCh can be asymptomatic or symptomatic with symptoms ranging from irritation, dry eye sensation, epiphora to localized pain, foreign body sensation, subconjunctival hemorrhage and ulceration. Mild asymptomatic cases dose not require treatment but follow up for progression symptomatic cases is oftently treated by lubricants, anti-inflammatory, steroids and eye batching in some cases may be needed. When these measures fail to relive the symptoms ,discomfort then surgery is the only choice with resection of an ellipse-shaped segment of the redundant conjunctiva just inferior to the lower lid margin and is usually followed either by suturing or amniotic membrane graft transplantation to restore a smooth tear film.Fibrin glue also has been used as a suture substitute to attach the conjunctiva or the amniotic membrane and was well tolerated. Conjunctival fixation to sclera is another modality of surgical treatment of CCh.Recently a new surgical approach with high-frequency radio wave electrosurgery and the use of diathermy produced a significant reduction in CCh and an improvement of symptoms. |