Anterior segment OCT assesses conjunctivochalasis progression with age

Stephen C. Pflugfelder, MD

This study found a significant increase in the prevalence of conjunctivochalasis with age in the nasal and temporal bulbar conjunctiva. This was associated with a progressive increase in the height of the central tear meniscus.
These findings are significant because the prevalence of eye irritation symptoms has been found to increase with age, yet irritation symptoms have shown poor correlation with conventional measures of dry eye, such as the Schirmer test and ocular surface dye staining.
This study suggests that age-related changes in the conjunctiva may be responsible for the increased eye irritation with aging due to mechanical trauma to the redundant conjunctiva with blinking, but also by altering the distribution and clearance of tears on the ocular surface. Tears are normally pulled up onto the ocular surface from the inferior tear meniscus and cleared into the lacrimal drainage system with each blink.
The obliteration of the temporal and nasal inferior tear meniscus by conjunctivochalasis interferes with these processes, resulting in poor refreshing of the pre-ocular tear film in the involved regions and stagnation of the tears in the central tear meniscus. This results in accumulation of inflammatory mediators and solutes that increases tear osmolarity and causes ocular surface inflammation and nerve sensitization.
The presence of an excess of tears in the central tear meniscus indicates that many cases of “dry eye” in the elderly are not due to a deficiency of tears but, rather, altered distribution and composition of the tears. This suggests the term “tear dysfunction” is more appropriate to describe this condition. It also indicates that doctors should examine patients with chronic eye irritation for the presence of conjunctivochalasis and if conventional treatments are not successful, removal or thermoreduction of conjunctivochalasis may be required to effectively treat the problem.