Conjunctivochalasis (CCH) is a condition where the conjunctiva, a thin membrane covering part of the white of the eye, becomes loose and wrinkled.

People with CCH may experience irritation and dry eyes, but they may also have an overflow of tears onto the face. This is because changes to the conjunctiva reduce its capacity to hold onto tears, which it needs to keep the eye moist and lubricated.

Some cases of CCH will not require treatment. For others, people may benefit from eye drops, gels, or surgery.

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CCH is also known as mechanical dry eye.

This condition affects the conjunctiva, which is the thin layer of tissue that sits between the eye and eyelid. It keeps the eye and inner surface of the eyelids moist and lubricated, as well as protecting the eye from small particles and germs.

If the conjunctiva becomes loose or wrinkled, the space available for holding tears becomes limited. This forces the tears out of the space, making it easier for the eye to dry out.

CCH is most common in older adults, and doctors often see it occurring alongside dry eye disease.

The symptoms of CCH include:

The symptoms of CCH are very similar to dry eye disease, and some research shows an association between the two conditions.

However, there are some differences between the two:

  • CCH symptoms typically get worse when a person looks down or blinks repeatedly.
  • Dry eye disease symptoms worsen when a person looks up and ease if they blink repeatedly.

While some cases involve no or mild symptoms, symptoms can greatly affect a person’s quality of life. In these cases, people should seek treatment from a doctor.

Mild CCH may not cause symptoms. In these instances, people will not require treatment.

Medication

For mild and moderate cases that cause some symptoms, doctors may suggest:

With CCH, the eye has a reduced capacity to hold moisture. This means that advanced cases will be more resistant to many of these forms of treatment.

Surgery

If medication does not help, doctors may recommend certain surgical approaches to treat the condition.

Typically, the aim with surgery is to remove some of the loose and wrinkled conjunctiva tissue. Doing so allows the body to maintain a steady pool of tears, keeping the eye and inner eyelid moist and lubricated.

If a doctor is treating CCH with surgery, they may:

  • cut out any excess conjunctival tissue
  • burn out any excess conjunctival tissue
  • use sutures to fix the conjunctiva tissue back in place properly

In some cases, a doctor may graft some tissue to smooth out the surface they have operated on.

Experts are unsure precisely why CCH occurs. As it tends to occur in older adults, many people consider it to be a condition that develops due to aging.

A leading theory is that the conjunctiva becomes loose and wrinkled when elastic fibers within this tissue begin to break down.

This breaking down may occur due to inflammation or friction from the eyelids against the conjunctiva.

Risk factors that may contribute to the development of CCH include:

Doctors will typically search for folds in the conjunctiva tissue using a device called a slit lamp. This is a microscope with a powerful torch attached to it, and this tool is often a part of eye examinations.

Using a slit lamp, eye doctors can identify if there are any folds in the conjunctiva. They may apply pressure to the eyelid or pull it away from the eyeball while looking.

There are a few different systems for grading how severe CCH is. One system involves the following grades:

  • Grade 0 — no persistent folds
  • Grade 1 — one small fold
  • Grade 2 — two or more folds, with none higher than the tear meniscus
  • Grade 3 — multiple folds higher than the tear meniscus

The tear meniscus is the lake of tears that forms where the eyelid connects to the eyeball.

A doctor may use other tests to distinguish a potential case of CCH from dry eye disease. These include Schirmer’s test, which assesses tear production, as well as tests to check how well tears cover the surface of the eye.

If a person with CCH receives the treatment they need, the outlook for this condition is favorable.

As CCH may occur alongside dry eye disease, some experts suggest that people may need to receive aggressive treatment to help treat the condition.

However, as some cases do not result in symptoms, it can be difficult to spot the disease and start treatment early.

Is conjunctivochalasis serious?

Some cases of CCH are mild and do not require any treatment. However, some cases can cause serious symptoms that require surgical treatment.

Why is my conjunctiva wrinkled?

The conjunctiva may become wrinkled due to elastic fibers within the tissue breaking down. This prevents the membrane from continuing to hold its shape and position.

CCH is an eye condition in which a membrane called the conjunctiva becomes loose and wrinkled. This lowers its ability to keep the eye and inner eyelid moist and lubricated, which can lead to dry and irritated eyes.

CCH does not always cause symptoms. People may be able to treat mild cases with medication in the form of eye drops, gels, and artificial tears. If these forms of treatment do not make a difference, surgery is a follow-up option.

CCH leads to irritation rather than eye damage. If a person with CCH receives appropriate treatment, the outlook for this condition is generally positive.