Conjunctival chalasis/demodex infestation

 
dgoldman

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Recently many surgeons have been excising conjunctiva with amniotic membrane grafting for conjunctivochalasis and prescribing tea tree oil for patients with suspected demodex. Have many surgeons in your area adapted this to their practice? For those people performing these treatments, how have your results been?


 
nfriedman

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Mild conjchalasis is common and does not require surgical repair. During 12 years of practice I have only seen 1 case severe enough to warrant surgery, so it's a pretty rare occurrence in the general community. Depending on how tissue is removed, amniotic membrane is certainly an option.

With regard to demodex and tea treat oil, I would only suggest this as a last resort. Demodex is ubiquitous and its role in the etiology/pathyphysiology of blepharitis is not clear. I've only heard anecdotal evidence to support tea tree oil therapy and tea tree oil is an irritant, so I would reserve its use for severe blepharitis unresponsive to more conventional treatment.


 
dmoshfeghi

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I have never seen a case of conjunctival chalasis. Any good photos to post?

Also, what is the tea tree oil postulated to do?


 
nfriedman

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Conjunctivochalasis is loosened/redundant conjunctiva that rests on or hangs over the lid margin. It is most commonly seen in elderly patients with dry eye and usually causes tearing (tears pool in the conj and drain down the lower lid because of the abnormal position of the loose conjunctiva). Sorry, don't have any photos.


 
dmoshfeghi

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Actually, have seen this in a patient following resolution of chronic chemosis due to gleevec therapy


 
dgoldman

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You probably unknowingly treat a lot of this when you perform your scleral buckling techniques and increase conjunctival adherence to the globe.


 
wlee

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I see conjunctival chalasis as a cause of tearing in my patients and have surgically exised the redundant tissue in a handful of patients for symptomatic and functional relief. I do not graft with amniotic membrane, but simply excise and let it heal on it's own.


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