When dry eye is more than dryness
Dry eye symptoms are not always caused by tear deficiency or meibomian gland dysfunction alone. In some patients, loose folds of conjunctiva — known as conjunctivochalasis — can interfere with the tear film, contribute to watering, cause foreign body sensation and make symptoms persist despite drops or other treatment.
At Earlam & Christopher, our Dry Eye Clinic now includes assessment for structural contributors to dry eye, including conjunctivochalasis. Where appropriate, we can discuss treatment options as part of a personalised dry eye management plan.
What is conjunctivochalasis?
Conjunctivochalasis, often shortened to CCH, describes loose or redundant folds of conjunctiva, usually along the lower part of the eye. These folds can disrupt the tear meniscus, increase friction and interfere with normal tear movement.
Common symptoms may include:
- watery eyes;
- gritty or foreign body sensation;
- burning;
- intermittent blur;
- mucous;
- discomfort on blinking;
- symptoms that do not fully respond to lubricants or other dry eye management.
How we assess it
Your assessment may include:.
- symptom questionnaire;
- slit lamp examination;
- tear film assessment;
- fluorescein staining;
- tear meniscus evaluation;
- meibomian gland assessment;
- imaging.
Treatment options
Not every patient with conjunctivochalasis needs a procedure. Some patients are best managed with dry eye therapy, anti-inflammatory care, lid management or monitoring.
For selected patients, a clinician-led plasma pen conjunctivoplasty procedure may be discussed. This aims to reduce redundant conjunctival folds and improve tear film mechanics. Suitability can only be confirmed after assessment.
Important safety note
All procedures carry risks and results vary. Treatment is only offered where clinically appropriate after careful assessment and consent. Some patients may require referral to an ophthalmologist.
Systemic medical contraindications
Do NOT treat if the patient has any of the following conditions:
General Health
- Pregnant or breastfeeding
- Pacemaker, ICD, or other critical electronic implants without cardiology clearance
- Known bleeding or clotting disorders
- On anticoagulants or antiplatelets that cannot be safely adjusted
- Poorly controlled diabetes or documented poor wound healing
Immune system and cancer
- Significant immunosuppression
- Chemotherapy, biologic agents, chronic high-dose steroids or advanced HIV
- Active cancer treatment or untreated malignancy, especially skin cancer near the area
Autoimmune and neurological
- Autoimmune connective tissue disease that impairs healing, such as lupus, scleroderma or severe rheumatoid arthritis on immunosuppressive therapy
- Uncontrolled seizure disorder
- Cognitive or psychiatric issues that prevent compliance with aftercare
Book a Dry Eye Assessment
Or, if you are already a patient of our Dry Eye Clinic, ask about a Structural Dry Eye Review.