This review sought to determine whether conjunctivochalasis (CCh) obliterates the fornix tear reservoir and thus mimics aqueous tear deficiency (ATD). Patients were divided into two groups, with aqueous tear deficiency (CCh +ATD) or without (CCh –ATD), based on results of fluorescein clearance test and their symptoms. Preop patients with ATD reported more symptoms of dryness, irritation, blurred vision, pain, and photophobia than those without ATD, who complained more often of watering. Changes in symptoms, basal tear volumes, use of medications, conjunctival inflammation and corneal staining were compared before and after fornix reconstruction, which included excision of mobile and degenerated Tenon membrane, fornix deepening and reconstruction with conjunctival recession and amniotic membrane transplantation. Basal wetting length increased significantly postop in both groups and this was significantly correlated with symptomatic resolution, significant resolution of corneal staining, conjunctival inflammation, and reduction in use of topical medications. However, eight eyes in CCh+ ATD group showed no improvement in basal wetting and little improvement in symptoms versus 10 eyes, which based on same criteria had resolution of their ATD. These results point to the fact that restoration of the fornix tear reservoir can lead not only to resolution of symptoms and signs related to CCh but also help to determine whether a low basal wetting length is related to low tear production by ATD or obliteration of the fornix tear reservoir by CCh. 

Restoration of fornix tear reservoir in conjunctivochalasis with fornix reconstruction.
Cheng A, Yin H, Chen R, et al.
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Magdalena Popiela

Royal Gwent Hospital, Cardiff, UK.

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