Conjunctivochalasis Interferes with Tear Flow from Fornix to Tear Meniscus

PurposeTo determine whether conjunctivochalasis (CCh) interferes with tear flow from the fornix to the tear meniscus and depletes the fornix tear reservoir.DesignComparative case series.ParticipantsThe study group of 24 CCh patients (8 asymptomatic and 16 symptomatic), 9 of whom underwent operative correction, was compared with a control group of 13 normal subjects.MethodsAfter instilling a 5-μl fluorescein drop into the inferior fornix, the inferior tear meniscus was depleted using a capillary tube. The tear meniscus height, with and without blinking, was recorded and calculated by video meniscometer from sequential captured images.Main Outcome MeasuresThe recovery rate of the original meniscus height was compared among groups at each time point after maximal depletion.ResultsThe recovery rate of the tear meniscus was significantly slower in symptomatic than asymptomatic CCh patients when compared with normal subjects. Blinking 5 times facilitated such recovery in normal subjects and in asymptomatic CCh patients to the same extent as the normal, but not in symptomatic CCh patients. Deepening of the inferior fornix by removing degenerated Tenon's and reconstruction by cryopreserved amniotic membrane improved the recovery rate in symptomatic CCh patients to the same extent as normal subjects.ConclusionsThe tear reservoir in the fornix rapidly replenishes the meniscus under normal circumstances. Conjunctivochalasis obliterates tears not only in the meniscus, but also in the reservoir, explaining how symptoms develop in CCh patients. Blinking is an effective compensatory mechanism to distinguish the severity of CCh. Surgical correction should not only restore the tear meniscus, but also deepen the fornix in CCh patients.Financial Disclosure(s)Proprietary or commercial disclosure may be found after the references.