Recognizing conjunctival chalasis avoids dry eye misdiagnosis
WAIKOLOA, Hawaii — Recognizing conjunctival chalasis depends on listening to the patient’s symptoms and investigating any report of a specific site of discomfort or foreign body sensation, a speaker said.
“Conjunctival chalasis occurs when there is a degeneration of Tenon’s fascia that ordinarily tethers the bulbar conjunctiva to the globe,” OSN Cataract Surgery Section Editor John A. Hovanesian, MD, FACS, said at Hawaiian Eye 2013. “This allows stretching and redundancy of the conjunctiva, which bunches up at the inferior lid margin, and sometimes elsewhere, and causes a foreign body sensation especially when the patient blinks.”
John A. Hovanesian
Conjunctival chalasis, which is a common and frequently misdiagnosed condition that mimics dry eye, is accompanied by signs of conjunctival redundancy.
Hovanesian recommends performing a “thumb test,” wherein the clinician, pressing gently on the lower lid externally over the area of discomfort, puts light pressure against the globe and asks the patient to move the eye back and forth in a direction that would deliberately cause gathering of the bulbar conjunctiva and pinching between the globe and the eyelid margin.
“When the patient complains of a specific site of pain, and there is evidence of conjunctival laxity, and there is a positive ‘thumb test,’ you’ve got your diagnosis of conjunctival chalasis,” Hovanesian said.
After making an attempt at lubrication with artificial tears, Hovanesian recommends surgical excision with ocular surface reconstruction with amniotic membrane. The technique is highlighted on his website at http://www.bettereyesurgery.com/video-library/.
Disclosure: Hovanesian is a consultant for IOP Ophthalmics.