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Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Epiphora is common in the first few post-operative days. Corneal irritation, which triggers hypersecretion of tears, and lower eyelid ectropion, which removes the inferior punctum from the surface of the globe, usually causes epiphora. Continued epiphora following blepharoplasty surgery may occur as a consequence of lagophthalmos with a secondary punctate keratopathy and hypersecretion of tears and/or a malposition of the inferior punctum. A subtle vertical positioning of the inferior punctum may result in epiphora. This is seen on careful slit lamp examination and may occur some years after surgery as the lower eyelid tarsoligamentous support becomes more lax. Conjunctivochalasis, a redundant fold of bulbar conjunctiva, may lie over the inferior punctum obstructing tear flow. This is again a subtle abnormality requiring careful slit lamp examination. It can respond to a conservative resection of the redundant conjunctiva. Persistent epiphora due to malposition of the inferior punctum requires further surgery to reposition the punctum.
Vision Impairment and Its Management in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Rajeev S. Ramchandran, Holly B. Hindman, Silvia Sörensen
Increased evaporation of tear film due to age-related changes in eyelid positioning (laxity, floppy eyelid syndrome, retraction, and lagophthalmos), meibomian gland dysfunction, rosacea, abnormal corneal sensation, and decreased blink reflex are more common in older adults.24,31,32 Malpositioned eye lids may be surgically corrected to avoid chronic blepharitis, chronic conjunctivitis, and superficial punctate keratopathy as without such correction, 50%–70% have been observed to develop dry eye syndrome.31 Conjunctivochalasis contributes to poor tear outflow and is characterized by redundant bulbar conjunctiva interposed between the globe and the eyelid.32 The prevalence of conjunctivochalasis increases dramatically with age from less than 71.5% in patients 50 years or younger to greater than 98% in patients above 61 years of age.33 Changes in corneal sensitivity, also more common in older adults, include hypersensitivity with increased ocular surface discomfort, and decreased sensitivity, which increased the risk of exposure keratopathy and associated complications. Neurodegenerative diseases, such as Parkinson’s disease, can cause decreased blink rate and reflex, which also leads to greater risk for exposure keratopathy. Aging also increases oxidative stress through increased inflammation and decreased ability of the body’s antioxidants to counteract free radicals. This alters the regenerative capacity of cells such as corneal epithelium, especially in dry eye conditions.34 Poorly healing epithelium can rapidly evolve into severe corneal conditions, such as erosions, keratitis, or ulcers, which cause vision loss in the older adults.
Factors that influence tear meniscus area and conjunctivochalasis: The Singapore Indian eye study
Published in Ophthalmic Epidemiology, 2018
Stanley Poh, Ryan Lee, Jennifer Gao, Carin Tan, Preeti Gupta, Charumathi Sabanayagam, Ching-Yu Cheng, Tien-Yin Wong, Louis Tong
Ageing is one of the most significant risk factors for development of conjunctivochalasis.10,14,30 In 2009, Mimura and colleagues postulated that flexibility of conjunctiva decreases with age, therefore increasing the severity of conjunctivochalasis.14 In our study, conjunctivochalasis was found to be the most severe in the temporal region, followed by nasal and central images; this was consistent with Mimura’s study, where the central conjunctivochalasis was reported to be less severe than nasal and temporal conjunctiva.14 In contrast to other studies, ageing did not affect TMA.31 This could be due to the adapting capacity of lacrimal functional unit homeostasis32 and that the majority of our study population was above 50 years of age.
The role of lid margin structures in the meibomian gland function and ocular surface health
Published in Expert Review of Ophthalmology, 2021
Sezen Karakus, Xi Dai, Xi Zhu, John D Gottsch
Conjunctivochalasis, regardless of lid laxity status, may also affect the dynamics and cause meibomian gland dysfunction. Conjunctivochalasis is characterized by loose, redundant conjunctiva that is more commonly seen with aging. Previous studies have shown that redundant conjunctiva between the globe and posterior lid margin reduces the tear meniscus area [60,61]. Similarly, redundant conjunctiva, particularly at an advanced stage, may prevent the ideal lid closure with the central space that is necessary for proper tear film mixing.
Evaluation of plasma assisted noninvasive surgery (PANIS) as a new approach for the treatment of conjunctivochalasis; a clinical case series
Published in Expert Review of Ophthalmology, 2021
Khosrow Jadidi, Nazanin-Sadat Nabavi, Mohammad Amin Nejat, Hossein Aghamollaei, Seyede-Yasamin Adnani, Bahar Nejat, Hanie Jadidi, Farhad Nejat
Conjunctivochalasis is one of the most common age-related eye diseases. For the severe type of CCh, various surgical methods have been reported. According to the reports, Hughes was the first to treat CCh by removing a section of the conjunctiva under the lower eyelid and closing the incision with a continuous black silk suture [14]. In addition, some studies described a method based on suture fixation of the conjunctiva to the sclera with 6–0 Vicryl sutures [15]. Furthermore, electrocoagulation is another method, which allows occurring a local inflammation for the attachment of conjunctiva to the subconjunctival Tenon’s capsule [15]. In this method, an electric current passes through the tissue. Accordingly, due to the contact of the cold electrode with the tissue, heat is generated, which causes the destruction of the target area. Disadvantages of this method are the possibility of damage to healthy tissue around the target due to the passage of electric current through the tissue. In addition, because electromagnetic waves are generated in this way, it may interfere with medical devices implanted in the body [16]. Transplantation of preserved human amniotic membrane for the treatment of CCh is another method where, after removal of the surplus conjunctiva by surgery, amniotic membrane is placed over and sutured with a 10–0 nylon suture to the free conjunctival edges [17]. Recently, simple electrosurgical procedures using high-frequency radio waves or electrical bipolar cauterization have been applied to treat CCh. Yang et al. (2013) evaluated the effectiveness of conjunctivoplasty for the treatment of patients with symptomatic CCh using an argon green laser [18]. By this method, the grade of CCh in 86% of the surgical eyes was decreased 6 months after the laser therapy. According to their report, the reduction rates of grades 1, 2, and 3 were 100%, 69%, and 48%, respectively. Hence, this method was suitable for patients with mild-to-moderate grade of CCh. Arenas and Muñoz (2016) represented a new surgical approach to treat CCh by reduction of the conjunctival fold using bipolar electrocautery forceps [19]. In their evaluations, all treated eyes showed significant improvement without scar lesions after following up a period of 10 months. Also, Trivli et al. (2018) introduced a quick surgical treatment of CCh using radio frequencies. In their study, CCh was evaluated according to the LIPCOF classification system. Of 40 treated eyes, 29 and 11 eyes had grade 1 and 2 CCh, respectively. After treatment, symptoms resolved in patients with grade 1 CCh and improved significantly for those with grade 2 CCh [15]. It should be noted that in all these methods, the patient needs to be hospitalized. Generally, in recent years, various methods have been proposed for the treatment of this disease. In all of them, the goal is to provide effective treatment with minimal surgery time and complications.