Can (CCH) Conjunctivochalasis (or anything to do with poor health) get better without surgery?
Maybe the better question is: How does our body repair itself and how can we assist it in that process?
General Wisdom is that our body turns over much of itself every 7-10 years. Corneal epithelium turns over every 2 weeks.
So it makes sense that outwardly irregular surfaces (or any disease state) can improve over time - assuming we take away the issues that drove it to “go bad” in the first place. I have seen degrees of improvement in CCH without surgery - the key is to start making enough quantity and quality of tears. With great tears, most symptoms of CCH improve (we see some patients with relatively severe CCH that have few if any related signs or symptoms). With poor tears, even mild to moderate degrees of CCH can become problematic and will tend to progress over time. This relates to the fact that plenty of good tears can wash easily over the eye with every blink - even with lots of pleats, folds and wrinkles in the conjunctiva (CCH). But with poor tears, those wrinkles really get in the way of the tears. Equally, if not more significant, the “gutter” or “reservoir” below the lower lid that is bordered by the eyeball, is shortened by the folds, so it can hold fewer tears.
My general push is to try every avenue that helps my patients make more and better tears before “fixing” the CCH (usually with the plications I’ve blogged on and published in my study). For more on CCH, see these earlier posts: https://www.eyethera.com/blog/what-is-conjunctival-chalasis-cch-and-why-should-i-care and for some embedded links to see how I actually do my treatments (and a study I published on the success of these treatments), see:
https://www.eyethera.com/blog/conjunctival-chalasis-cch-part-2-how-do-we-fix-it
Lastly:
https://www.eyethera.com/blog/cch-part-3-when-do-we-treat-cch-and-what-are-the-options
Healthy tears are also critical to healing the surface of the eye - so if, after working hard to improve the amount and quality of tears, the total volume is still suboptimal, then it often makes sense to fix the CCH, so that what a patient has for a tear, can better do its job.
Much research is being aimed at finding better ways to heal the surface when the tears are not up to the job. If the nerves are damaged (common in dry eye disease), then healing the nerves may be needed first. My earlier post on healing a “broken” surface of the eye is found here: https://www.eyethera.com/blog/what-to-do-when-the-surface-of-your-eye-gets-broken-scratched-operated-on-infected-or-otherwise-damaged A French study is underway to test another source of biologic material (Wharton’s Jelly - the material between the umbilical cord and the amnion) to heal poorly healing corneal surfaces: https://www.ophthalmologytimes.com/view/upcoming-trial-aims-to-measure-effectiveness-of-wharton-s-jelly-eye-drops-in-keratitis-treatment?utm_source=sfmc&utm_medium=email&utm_campaign=09062023_OT_eNL_Dry%20Eye%20house%20ad_CRU%20house%20ad&eKey=ZWphY2NvbWFAYW9sLmNvbQ==
For those interested in how the cells of the human body “turn over” every 7-10 years, I’ll first note the proviso that turnover does not mean we don’t age (seems obvious) - but it is pretty cool to understand the way our bodies work. This article helps explain how this works (or doesn’t work for some cells): https://www.livescience.com/33179-does-human-body-replace-cells-seven-years.html