Conjunctivochalasis: literature review and possible pathophysiology

Conjunctivochalasis, defined as a redundant conjunctiva typically located between the globe and the lower eyelid, is not uncommon. However, it is often overlooked, as it may be considered a normal senile change. Conjunctivochalasis can cause a spectrum of symptoms, ranging from aggravation of a dry eye at the mild stage, to disturbance of tear outflow at the moderate stage, and exposure problems at the severe stage. Clinical recognition of its pathogenic role helps differentiate conjunctivochalasis from other diseases that may generate similar symptoms. For symptomatic patients, topical lubricants can be tried, but they are frequently unsuccessful, and surgical excision may be required. To guide future investigation into the clinical significance of conjunctivochalasis, a comprehensive grading system and a hypothetical pathophysiology are proposed. Special attention is given to the relationship of conjunctivochalasis to tear dynamics.