A CCH Case Study: Addressing the Real Cause of Conjunctivochalasis (CCH)


An optometrist in my office referred a 69-year-old male patient, who for years had been treated for dryeye with RESTASIS, and occasionally Lotemax. At the time, he also wore scleral lenses to try to combat his dry eye. After years of struggling and trying different treatments, he still had no relief.

Identifying Conjunctivochalasis: The Importance of Restoring the Tear Reservoir for Patients with This Condition

I was an early adopter of identifying conjunctivochalasis (CCh) and addressing it as a true pathologic condition from which our patients suffer. Conjunctivochalasis dry eye, as it is often called, is truly a misnomer. While CCh contributes to dry eye symptoms, it is a separate entity from the “standard dry eye” that we see in our practices. Furthermore, a number of myths are associated with CCh.

CCh presents as dissolved and degenerated Tenon’s with excess, loose conjunctiva in the inferior fornix, and fat prolapsed into the inferior cul-desac. This results in both the obliteration of the tear reservoir within the inferior fornix and obstruction of the tear meniscus along the inferior eyelid margin. Normal tear distribution and outflow are disrupted, and the patient experiences dry eye symptoms.

A Safe, Effective Procedure for Conjunctivochalasis

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.

Dry Eye CCH: It's a Tenon's Problem

An estimated 3.2 million women and 1.68 million men age 50 and over are affected by Dry Eye Disease, and the demographics are growing rapidly among Baby Boomers who work on computers all day. Dry Eye can be quite uncomfortable for patients and tends to get worse if left untreated, leading to pain, scarring, and in many cases fluctuating vision, which may cause intermittent loss of vision.

All of these symptoms can be frustrating, especially for the patient, as well as the doctor. Making the diagnosis is the key to effective treatment. Communicating effectively with the symptomatic individual is also critical.