Novel way to treat conjunctivochalasis

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To the Editor:

Conjunctival chalasis (conjunctivochalasis) seems to mean different things to different people (See related article here). I apply this term to a condition where there is an excess of conjunctiva. The conjunctiva may vary from a slight elevation with wrinkling to a cystic elevation the size of a grape. The conjunctival elevation may be caused by an irritation from dry eye, a spastic entropion, etc.

Fluid is secreted into the subconjunctival area, which elevates the conjunctiva. Patients may want elevated conjunctiva released due to discomfort or for cosmetic reasons. I suggest an easy way to release both the elevated conjunctiva and the subconjunctival fluid. May I call it the “EARL” or EAsy ReLease procedure?

One simply places the warm tip of a hand-held, disposable cautery on the surface of the conjunctival chalasis. The warm tip will produce a hole in the conjunctiva. The fluid under the conjunctiva will run out through the hole, and the chalasis will collapse. The heat produces a coagulum around the conjunctival hole that sticks the conjunctiva to the subconjunctival tissues.

One hole is all that is needed. I explain the procedure to the patient and provide him with an antibiotic drop to use for a few days prior to the procedure. One needs to place a topical anesthetic in the eye and then insert a strong eye speculum. Turn the cautery on and then turn it off and wait a few seconds so the tip will be warm but not very hot.

If the tip is too hot the patient will feel the heat and jump. I have not had to repeat the procedure but I’m sure that one may repeat it if necessary. I understand some surgeons excise conjunctiva and may place an amniotic membrane graft. I have not found this necessary.

-Earl Braunlin, MD Fort Wayne, IN

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