Restoration of Fornix Tear Reservoir by Amniotic Membrane Transplantation in Conjunctivochalasis

Abstract

Conjunctivochalasis (CCh) presents as loose and redundant conjunctival folds interspersed between the globe and eyelids (Surv Ophthalmol 43:225–232, 1998) and may cause a variety of ocular symptoms that mimic dry eye (Br J Ophthalmol 88:388–392, 2004). CCh disturbs the preocular tear film by blocking the tear drainage, disrupting the tear meniscus, and obliterating the fornix tear reservoir (Cornea 35:736–740, 2016) to interfere tear flow from the fornix reservoir to the tear meniscus (Ophthalmology 120:1681–1687, 2013). A number of surgical procedures have been advocated to treat CCh. Most of these procedures focus on elimination of conjunctival folds close to the tear meniscus but do not address obliterated tear reservoir in the fornix. In this chapter, we summarize a novel surgical technique not only to eliminate the wrinkled conjunctiva in the tear meniscus but also to restore the tear reservoir in the fornix by a significant rearrangement of conjunctival tissue by recession from the limbus to the fornix and by ocular surface reconstruction with amniotic membrane transplantation for the missing Tenon’s capsule and the bulbar conjunctiva. Consequently, such a procedure addresses a major disturbance of the tear spread from the fornix to the tear meniscus, which is one important strategy as a practical and effective clinical management algorithm for dry eye (Cornea 35:736–740, 2016).