Dry Eyes From Baggy Eyes

Often overlooked, conjunctivochalasis is a common condition that occurs with aging and can lead to dry eye symptoms. The conjunctiva is the transparent loose layer of tissue that covers the white part of the eye. With maturing years it can lose its elasticity. It also loses the attachment to the underlying white part of the eye, the  sclera. The loss of attachments and elasticity is responsible for the formation of thin,  loose folds of tissue.  This normally occurs in the lower part of the eye just above the bottom eyelid.  The conjunctiva also connects to the tissue surrounding the back 2/3’s of the eye referred to as Tenon’s Capsule.  With the degeneration of the conjunctiva this adherence to Tenon’s Capsule can break down at the eye lid margin and disrupt normal formation of a prism like strip of tears along the lower eyelid. This thin strip of tears functions to work in a squeegee like manner with every eye blink and route tears into the puncta. The puncta is a small drainage opening in the lower eyelid that empties the tears into the canicula, the channel leading the tears outside of the eyes. Inflammatory compounds like cytokines start building up when tears are not regularly flushed out of the eye.  Tears are normally spread out evenly across the front surface of the eye with each blink, very similar to how a windshield wiper functions. This clears vision with a new stable tear film every time you blink.

Eye Symptoms With Conjunctivochalasis

With conjunctivochalasis the redundant folds of tissue interfere with the normal resurfacing process. Just like trying to drive in a rainstorm with broken wiper blades vision can be compromised. Eye discomfort also increases as the tear film breaks up faster than the blinking cycle can form a new surface of tears. (Tear gas has a similar but exaggerated effect in disrupting the stability of the tear film). The redundant rolls of conjunctival tissue also can cause epiphora, a condition where tears fall onto the skin under the eyes. The eyelids loose some of their elasticity with age and do not stay as firmly against the eye which compounds this problem. The result can be similar to classic dry eye syndrome with constant tearing.  A dry eye from lack of the watery component of tears will usually get worse as the days progresses since the eye dries more when it is open and exposed. In a normal dry eye caused by a lack of the water component of tears blinking often provides temporary relief from resurfacing the tear layer. With conjunctivochalasis the discomfort tends to remain the same throughout most of the day, and blinking will exacerbate  the discomfort and reduced acuity of sight.

Eye Treatment of Conjunctivochalasis

A commonly used treatment for dry eyes are punctal plugs. Punctal plugs are tiny silicone stoppers inserted into the drainage ducts for the tears, the puncta. Since the tears are not draining properly due to the redundant tissue folds, occluding the tear drainage system with punctal plugs will only increase the symptoms. There is still debate whether conjunctivochalasis actually causes a form of dry eye or simply mimics some of the symptomology. Treatment suggested include using artificial tears that prolong the stability of the tear film. Anti inflammatory eye-drops may also be used to reduce the inflammatory compounds that concentrate in the tear film. Frequently there is accompanying obstruction of the tear drainage duct that can be cleared to help alleviate discomfort. Surgical treatment of severe cases is a procedure referred to as a conjunctival peritomy. This creates an incision in the conjunctival tissue and an amniotic membrane is transplanted on top.