Blepharoplasty
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in 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
K. Rao Poduri in Geriatric Rehabilitation, 2017
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
Apart from measuring the tear meniscus, ASOCT can simultaneously detect structural changes of the ocular surface. A common condition is conjunctivochalasis. In this condition, the redundant conjunctiva located between the globe and lower eyelid obliterates the inferior tear reservoir, which disturbs temporal to nasal flow of tears.10,11 In this context, ASOCT has proven to be useful as it can provide objective evaluation of conjunctivochalasis morphology.12,13 Previous studies evaluating conjunctivochalasis in a population-based sample assessed the condition via subjective definition via slit-lamp examination.14,15 Currently, there are no reported use of ASOCT-based assessments of conjunctivochalasis in a population-based sample.
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.
Uniocular Conjunctivochalasis and larger diameter PROSE lens
Published in Clinical and Experimental Optometry, 2022
Sona Paul, Bhaskar Srinivasan, Geetha K Iyer
The patient reported here had post-inflammatory conjunctivochalasis, and was symptomatic despite two previous surgical excisions. The patient responded favourably upon treatment with PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem) (Boston Foundation for Sight, Needham, Massachusetts, USA). The legal guardian (father) of the patient gave written informed consent for the use of clinical records and pictures included in this case report.
Related Knowledge Centers
- Conjunctiva
- Dry Eye Syndrome
- Epiphora
- Bleeding
- Corneal Ulcer
- Sclera
- Tenon'S Capsule
- Blepharitis
- Meibomian Gland
- Ehlers–Danlos Syndromes