For many patients suffering from constant eye irritation, redness, and swelling, their symptoms can affect their daily activities and work. By the time I see some patients with these types of symptoms, many have already been to numerous doctors and tried all types of medications and artificial tears with no relief. Although these symptoms may seem like Dry Eye, for some patients they are actually a common condition called Conjunctivochalasis (CCh), that is often confused as Dry Eye due to similar symptoms. They may complain about having dry eyes, but are actually tearing.
Left: Image of patient with CCh before Reservoir Restoration Procedure
Right: Image of patient after Reservoir Restoration Procedure
Photos courtesy of Peter J. Polack, MD, FACS
CCh, which generally affects patients over the age of 50, is loosened, shortened, and wrinkled conjunctiva, which interferes with the tear meniscus and diminishes the fornix or tear reservoir. This is caused by the underlying Tenon’s capsule being degenerated or dissolved by matrix metalloproteinase (MMPs). This wrinkled tissue occupies the tear reservoir and prevents the eye from holding tears, causing pain and irritation that feels similar to Dry Eye symptoms. Because it can mimic Dry Eye, it is often overlooked and underdiagnosed.
While there are differing techniques for CCh, none currently address the Tenon’s capsule. Fortunately, there is now a simple procedure, called the Reservoir Restoration Procedure that restores the tear reservoir and tear meniscus to their natural states and inhibits MMP activity using cryopreserved amniotic membrane. The procedure can be performed without sutures (as described by Neel Desai MD). This simple, surgical procedure restores the function of the anatomical tear reservoir (fornix) by:
- Removing deteriorated Tenon’s capsule
- Rearranging conjunctiva or trimming if necessary
- Deepening the fornix
- Using multiple-layers of cryopreserved amniotic membrane to replace the Tenon’s and conjunctiva
Since most patients are not familiar with this condition, I find it helpful to either draw the relevant anatomy on a dry erase pad or show them a video which explains the procedure. Once they understand what is involved, they are usually amenable to the surgery. Many of these patients are figuratively at ‘the end of their rope’ when it comes to their misery.
The procedure, which is safe and relatively painless, takes about 20 minutes, and helps expedite the patient’s recovery by reducing inflammation and promoting regenerative healing. With the new tissue in place, a reservoir of tears can form properly and keep the patient’s eye lubricated, which eliminates the symptoms that have been affecting them. The results can be life changing, improving patients’ quality of life and allowing them to resume their normal activities and active lifestyles. In fact, many patients will report improvement in their symptoms within a few days.
Peter J. Polack, MD, FACS, specializes in refractive surgery, cornea and external diseases. Dr. Polack, who practices in Ocala, Florida, lectures on dry eye, has published articles and abstracts, and has co-authored ophthalmology textbooks. To learn more about Dr. Polack's success with the Reservoir Restoration Procedure, click here.