More about CCH (When the eye’s white surface turns to a washboard and tears have an obstacle course…)

I was recently asked how important the fornix is to Conjunctivochalasis (CCH) and should it be restored in CCH surgery.

The “fornix” is the reservoir or “well” that contains our best tears, in that those tears have yet to be used for supporting the exposed surface of the eye. The exposed tear is becoming the old, used-up, dried up, dirty tear that needs to be replaced and a blink is that “heartbeat” that renews that support by turning over that tear. So preserving the fornix is important. (We want a deep well, capable of holding a lot of healthy, fresh tears.)

Some technologies that excessively burn and damage the conjunctival tissue that has come loose and otherwise “rides up” (shortening the fornix) can risk “over-tightening” and foreshortening the reservoir (shortening the depth of the “well.”) Higher levels of heat, applied in broad swaths, can cut, burn and scar down that membrane. In my experience, radio frequency can straddle the line between tightening and over tightening - and can seal the conjunctiva over the white of the eye (sclera) without damaging the reservoir function. The lighter degrees of heat can be applied in serial, linear passes - sequentially shrinking and “shrink wrapping” that membrane - with just enough of a “burn” in places as to heal and “stick” the membrane back in place.

Excess burning causes higher levels of scarring and tightening, which may, for some patients, risk significantly reducing that fornix. An alternative is cutting away the excess conjunctiva and either allowing it to then heal - or gluing amnion over the exposed white tissue (sclera). Either can restore the fornix but doesn’t fix the problem (MGD and evaporative dry eye) causing the problem (CCH).

Off-label use of RF as described in my studies, has been shown to improve MG function, so combining both the RF plication (shrink wrapping the membrane) with the RF -heated expression of wax-clogged glands has made more sense to me. There are some relative contraindications to RF (an active cardiac pacemaker being one), so there are times where I’ll turn to alternative methods.

Some of my posts relating to CCH, including this most recent post here:

https://www.eyethera.com/blog/can-conjunctivochalasis-get-better-without-surgery

And my earlier series on CCH - part 3: When do we treat CCH – and what are the non-surgical options?

Jun 12

Written By Dr. Edward Jaccoma, MD

https://www.eyethera.com/blog/cch-part-3-when-do-we-treat-cch-and-what-are-the-options

Conjunctival Chalasis (CCH) part 2 - How do we fix it?

Jun 5

Written By Dr. Edward Jaccoma, MD

https://www.eyethera.com/blog/conjunctival-chalasis-cch-part-2-how-do-we-fix-it

What is Conjunctival Chalasis (CCH) and why should I care?

May 29

Written By Dr. Edward Jaccoma, MD

https://www.eyethera.com/blog/what-is-conjunctival-chalasis-cch-and-why-should-i-care

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463