الفهرس 
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Abstract
Conjunctiva is a translucent mucous membrane which
covers the anterior surface of the eyeball and the posterior surface of the eyelids.
The term conjunctivochalasis, taken from the Greek term
meaning “relaxation of conjunctiva”. Conjunctivochalasis (CCh) is
described as a redundant, loose, non-edematous inferior bulbar conjunctiva interposed between the globe and the lower eyelid. The
condition tends to be bilateral and can be localized in the medial,central, or lateral part of the lower eyelid, it is not uncommon but often overlooked as a normal ageing variation.
The exact underlying cause of conjunctivochalasis is
unknown. But it was considered as a senile change. Alternatively,both elastotic changes and collagenolysis might independently
contribute to the formation of conjunctivochalasis. The preferential involvement of the inferior bulbar conjunctiva and lid margin
strongly suggests that the insult leading to the elaboration of the degrading enzyme is derived from tears accumulated in the inferior
fornix and the tear meniscus due to delayed tear clearance which may be linked to inflammation , dry eye, also conjunctival trauma produced by vigorous patient eye rubbing that could cause
conjunctivochalasis with an associated inflammatory reaction .It was speculated that conjunctivochalasis may be another cause of delayed tear clearance which in turn causes an increase in
collagenolytic activity and establishes a vicious cycle.
Classification of CCh which was first based on the number
of folds and the height of the redundant conjunctiva with respect to that of the tear meniscus in grades from 0-4 and then was modified
to include the extension of conjunctivochalasis and gaze-dependent changes. Digital pressure was included as a factor in estimating the
extent of severity.
CCh can be asymptomatic or symptomatic with symptoms
ranging from irritation, dry eye sensation, epiphora to localized pain, foreign body sensation, subconjunctival hemorrhage and ulceration.
Mild asymptomatic cases dose not require treatment but
follow up for progression symptomatic cases is oftently treated by lubricants, anti-inflammatory, steroids and eye batching in some
cases may be needed. When these measures fail to relive the symptoms ,discomfort then surgery is the only choice with resection of an ellipse-shaped segment of the redundant conjunctiva just inferior to the lower lid margin and is usually
followed either by suturing or amniotic membrane graft
transplantation to restore a smooth tear film.Fibrin glue also has been used as a suture substitute to attach
the conjunctiva or the amniotic membrane and was well tolerated.
Conjunctival fixation to sclera is another modality of surgical treatment of CCh.Recently a new surgical approach with high-frequency radio wave electrosurgery and the use of diathermy produced a significant reduction in CCh and an improvement of symptoms.