conjunctivoplasty?

[gracie99]

Saw a doctor who specializes in occuplastic surgery today for cautery.

He noted two abnormalities that were new to me: Conjunctivochalasis (excess conjunctiva) and some distortion of how my lower lid closes.

According to this doctor, the combination of the excess conjunctiva and the subtle lid closing problem results results in the conjunctive being pinched a bit each time I blink -- and that, supposedly, is what makes my eyes perpetually bloodshot and irritated.

He proposed a bit of minor surgery in which he would cut away the excess conjunctiva (conjunctivoplasty) from deep in the lower eye socket and reposition a tiny muscle near the inner corner of the lower lid to make it close better.

I'd like to hear comments on this surgery, please.

This doctor felt that the risks are very minor. He said that only one of his patients had any difficulty after this, saying that when she looks sideways very far, she has some sensation of pulling under the eye and a little visual doubling.

(He didn't want to do this surgery, however, until my dry eye problems are improved, hopefully through the cautery done today.)

[Lucy]

Gracie, I would suggest LOTS of research and SEARCH this forum for articles pertaining to this procedure. Did he mention cost? Usually when someone mentions this is seems like ......$7,000 or $8,000. I do not know if it's covered by insurance or not.

I believe some people have had this surgery, usually traveling a great distance and were not happy with the outcome. Watch you don't have needless procedures, use second and maybe third opinions and take your time deciding on this. Lucy

[Rebecca Petris]

Cost can vary a LOT on this - I think it's the ones that do amniotic membrane grafting after the excision that cost so much though I'm not sure. I've known of some well under $1000. Sounds like this one is just talking about excision. I think that excision can be useful for some people but personally I think the doctor needs to be convinced that the conjunctivochalasis is actually causing a problem before trying to fix it. Sometimes people with this condition kind of look like nails to a guy with a hammer if you know what I mean (no offense at all to your doctor). Bloodshot, irritated eyes can get that way from dryness, and it's reasonable to imagine the lid and conj are contributing but hard to be sure.

Lid surgery always concerns me simply because I hear from so many of the exceptions where dry eye is either caused or made worse through increased exposure.

On the dry eye theme: If you DO decide to go ahead with the surgery (ies), even if you're working with a really good oculoplast, only do this if you have a really good cornea doc involved throughout (i.e. one cooperating with the oculoplast). If you are dry now and are getting cauterized and then waiting for improvement before surgery, make sure you give it enough time. Occluding the puncta can give lasting benefit to many people but not all - some go through a honeymoon. With the season changing too - heat not on so much - it's all too easy to attribute improvement in dry eye to the most recent treatment. So I guess my advice is, what Lucy said: Wait, and study more.

[TARYN]

Hi Gracie,

I had both surgeries that your doctor is recommending. I had good outcomes with both of them. I had a canthoplasty and alloderm spacer with an oculoplastic surgeon to lift my lower lid and AMT surgery with a corneal specialist for the conjunctivochlasis.

[gracie99]

The oculoplast did recommend that we try to get better control of the dry eyes -- hence the cautery -- before evaluating whether the conjunctivoplasty seems necessary.

I hit maximum out-of-pocket for my insurance already this year, so cost isn't an issue -- it will cost me nothing if done in the next few months.

[gracie99]

How long does it to heal after cautery and get an idea of good results? Would 6 weeks be enough time?

(This is my bad dry eye season, when it is complicated by pollan allergies, so if it works in spring, it should work better in other seasons.)

I think excision -- snipping away the extra conjunctiva way down in the bottom of the eye socket -- was what he was talking about, except for the reposition of some small muscle.

Why would a cornea doc need to be involved even though this operation doesn't seem to involve the cornea?

Noticed in a poll here that most people here who have very dry eyes do not have perpetually red 'whites' as I do. And most seem able to use at least gentle eyedrops --apparently all dry eyes aren't necessarily extremely irritable as mine are. So that makes me inclined to think that there is more than just dry eyes going on.

Thanks for the advice.

[TARYN]

I went to a doctor that specializes in the conjunctivochalasis surgery and he was a corneal doctor. Just make sure whoever you go to has lots of experience with this type of surgery and does it on a regular basis.

[Rebecca Petris]

Why would a cornea doc need to be involved even though this operation doesn't seem to involve the cornea?

I don't mean involved in the operation. I mean consulting on your case to ensure your corneal surface is in OK shape beforehand and gets the best possible treatment afterwards. In a large opthalmology practice where there's an oculoplast and a corneal specialist they'll tag-team care in this way sometimes esp. with lid surgeries in someone with preexisting dry eye.

Noticed in a poll here that most people here who have very dry eyes do not have perpetually red 'whites' as I do.

There are quite a few actually and the causes vary.

[gracie99]

After cauterization of lower puncta yielded only modest improvement in my very dry eyes, I decided to go through with the oculoplastic surgeon's suggestion of conjunctivaplasty (sp?) and another minor procedure to tighten the inside half of my lower eyelids.

The surgery was about 5 weeks ago. MY EYES NOW FEEL GREAT! I'm not using drops at all, and MY EYES FEEL MOIST AND COMFORTABLE almost all the time, despite a lot of computer use.

The gapping in the lower eyelid was almost unnoticeable. The surgeon said that he could just barely detect it when I blinked, but that the dryness disclosing drops he put in my eyes indicated that the nose-side of my eyes was by far the driest area. I'd never noticed that until he pointed it out and I started paying attention to what part of my eyes felt most dry.

I had noticed the excess conjunctiva, but had never thought anything of it. The doctor said that excess conjunctiva can cause a slight amount of irritation on every blink.

Both problems, according to this doctor, are fairly common. In his experience, cautery alone for people with those conditions rarely solves their dry eye problem, but correction of the two conditions yields much better results.

Recovery took almost a month, and in my case was complicated by a bad reaction to the stitches that the doc said he sees in about 3% of patients.

The procedures were done while I was awake, using local anesthetics plus a modest dose of oral painkiller and a small dose of anti-anxiety medication. There was little pain and a modest amount of discomfort.

(The healing period was the worst part: I looked like I'd lost a prize fight for a couple of weeks afterwards.)

The bloodshot appearance of my eyes has also improved considerably. The doctor told me that there will probably be even more improvement over the next couple of months.

My oculo-plastic surgeon is Scot Sullivan in Portland, Oregon.

[TARYN]

Gracie99,
Congratulations. My surgeries also worked very well. The redness and burning were gone after my surgeries also.

[littlemermaid]

John A Hovanesian MD on conjunctival chalasis http://www.youtube.com/user/johnhova#p/u/6/BNI8dZ55v1I

Loose conjunctiva on the eye surface: foreign body sensation, occurs on movement, dry eye history, usually over 50, maybe history of surgery. Enjoy the maestro at work.

[spmcc]

He says that dry eye normally does not present with pain and so, if pain occurs, doctors should think of conjunctivochalasis. That's kinda weird to me!

But I'm still going to get checked out...

[littlemermaid]

Dr Latkany post: There are several options for this from topical drops to surgery. http://www.dryeyezone.com/talk/showthread.php?t=10700

[drusen]

I found it was somewhat hard to find information about Conjunctivochalasis on the web so I added the disorder to Wikipedia:
http://en.wikipedia.org/wiki/Conjunctivochalasis

I included some stuff I'd gleaned in my research and a pic I have but I'd be grateful if any of you guys with the disease would like to add more info.


Thanks


Drusen

[soxboy]

After years and years of suffering from constant bloodshot and glassy eyes , I will have the surgery on Thursday........I pray it works and ends my years of agony with this relentless condition.................

[Anne_8]

I'm a new poster but have been using the site for a while. My doctor recently diagnosed this and mentioned the surgery. I'd love to get some follow-up from those who've undergone the procedure and can comment on their results ( or lack of them ).

Thank you!!

[SusieQ]

I am having this surgery next month and really would like to know about pain and recovery time. I hope you had success with the procedure! Thank you for any info you may be able to share!