Part 1: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

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In part one of a two part series, Arla Genstler, MD, discusses Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduces us to the Reservoir Restoration Procedure for CCH.

What is Conjunctivochalasis (CCH) Dry Eye?

Dr. Genstler: Conjunctivochalasis (CCH) is a mechanical problem caused by the degeneration of the Tenon’s Capsule due to high matrix metalloproteinase (MMP) activity. The unhealthy Tenon’s causes the conjunctiva to loosen and create folds that can interfere with the tear meniscus, block the punctum preventing tear clearance, and occupy the fornix (the tear reservoir) diminishing its volume and ability to adequately hold fluid needed to replenish the tear meniscus. Over time the loose conjunctiva contracts, further shortening the fornix.

How do you diagnose Conjunctivochalasis (CCH) Dry Eye?

Dr. Genstler: CCH can be diagnosed at the slit lamp exam. It’s easy to see the redundant folds of conjunctiva, typically laterally, but they can extend across the entire inferior conjunctiva. In patients with CCH Dry Eye, their eyes are unable to hold enough tears, which causes pain and irritation similar to aqueous tear deficient dry eye symptoms. However, these patients don’t respond to maximum medical treatments such as artificial tears, anti-inflammatories, and lid wipes. In patients with CCH, the wrinkled tissue that occupies the tear reservoir can also be visible at the lid margin.

What is the Reservoir Restoration Procedure for CCH?

Dr. Genstler: The Reservoir Restoration Procedure for CCH is the only procedure for CCH that addresses the inability for the eye to hold fluid. While there are differing techniques for addressing CCH, this procedure is the only one that addresses the tear reservoir. By using cryopreserved amniotic membrane (AmnioGraft), a smooth ocular surface is recreated, the inferior fornix is reconstructed, the function of the tear reservoir is restored, and superior cosmetic results are achieved.

Why are you so excited about performing the Reservoir Restoration Procedure for CCH?

Dr. Genstler: Unlike ocular surface diseases that are multi-factorial making them challenging to treat, CCH can truly be fixed – that’s the exciting thing as it’s fundamental to providing the reservoir for tears. This procedure actually fixes the problem and re-establishes normal anatomy and function, which then greatly improves the stability of the tear film. The procedure is ideal for those patients where it’s evident that there is an anatomic problem and other treatments have failed.

 In part two of her series, Dr. Genstler will speak in more depth about the Reservoir Restoration Procedure for CCH and its clinical results.

 

"Conjunctivochalasis Interferes with  Tear Flow from Fornix to Tear Meniscus"


Arla Genstler, MD, is a cataract and refractive surgeon at Genstler Eye Center in Topeka, Kansas. She is board certified by the American Board of Ophthalmology and a Fellow of the American Society of Cataract and Refractive Surgeons. Her practice has three offices and a stand-alone surgery center, and is one of the leading refractive and cataract practices in Kansas.