Conjunctivochalasis (CCh)


Conjunctivochalasis (CCh) represents one of the most common age-related eye diseases and is characterized by the presence of redundant folds of the conjunctiva that typically are detected between the eyeball and the eyelids. It is commonly found along the lower lid margin and   mechanically interferes with the normal distribution of tears giving rise to unstable tear film (dry eye) and delayed tear clearance (epiphora). The differences between CCh-induced dry eye and aqueous tear deficiency (ATD) are summarized in Table 1. For asymptomatic CCh, no treatment is needed, and patients may be given tear substitutes, lubricants, corticosteroids or antihistamine drops. Persistent symptomatic CCh despite maximal medical treatments to dry eye can be treated using amniotic membrane (AM) transplantation.

Distinguishing Feature ATD Dry Eye CCh Dry Eye
Diurnal Variation Worse in PM Same throughout the day
Worst gaze Up gaze Down gaze
Effect of vigorous blinking Symptom improved Symptom worsened
Recurrent subconjunctival hemorrhage Infrequent Frequent
Fluorescein Staining Pattern Low tear meniscus without interruption Tear meniscus interruption or obliteration
Tear Clearance Normal/Delayed Frequently delayed
Rose Bengal Staining Exposure zone Non-exposure zone
Effect of Punctal Occlusion Symptom improved Symptom worsened


  • CCh before AMT

  • After AMT

Methods of detecting CCh

  • Vigorous blinking under slit lamp

  • “Tenting” by 0.12 forcept

  • Press finger to the lid against globe 1

  • Press finger to the lid against globe 2

Conjunctivochalasis Surgical Guides

[Expand all]

  • Diagnosis of Conjunctivochalasis
  • Supplies for Conjunctivochalasis Surgery
  • Surgical Techniques for Inferior Conjunctivochalasis
  • Conjunctivochalasis with Pinguecula
  • Conjunctivochalasis with Fat Prolapse
  • Pterygium Post-Operative Care
  • Post Operative Care
  • Frequently Asked Questions


Cryopreserved Amnion Grafts for Conjunctivochalasis and Superior Limbic Keratoconjunctivitis
Conjunctivochalasis Diagnosis, & Differentials
Conjunctivochalasis Surgical Proecedure
Conjucntivochalasis Pre & Post Operative Images




  1. Meller D, Tseng SCG. Conjunctivochalasis: literature review and possible pathophysiology. Surv Ophthalmol. 1998;43:225-232.

  2. Yokoi N, Komuro A, Maruyama K, Tsuzuki M, Miyajima S, Kinoshita S. New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis. Am J Ophthalmol. 2003;135:303-308.

  3. Di Pascuale MA, Espana EM, Kawakita T, Tseng SC. Clinical characteristics of conjunctivochalasis with or without aqueous tear deficiency. Br J Ophthalmol. 2004;88:388-392.

  4. Di Pascuale MA, Espana EM, Tseng SCG. Clinical importance of conjunctivochalasis in dry eye management. EyeNet. 2004.

If you have additional surgical questions after viewing this information, contact OSREF's Research Director, Scheffer C.G. Tseng, MD, PhD, by e-mail at or by phone at 305-274-1299.

Videos edited by: Scheffer C.G. Tseng, MD, PhD, Hosam Sheha, MD, PhD, Ahmad Kheirkhah, MD, Antonio Elizondo, MD, Victoria Casas, MD

Note: The videos are for peer discussion purposes and the creators are not participating in commercial promotion of any product.

Financial Interest Disclosure: Dr. Tseng and his family are more than 5% shareholders in TissueTech, Inc. and Bio-Tissue, Inc. which currently distributes AMNIOGRAFT® and PROKERA™

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