ocular surface abnormalities

Lid parallel conjunctival folds (LIPCOF)

sub-clinical folds in lateral, lower quadrant of bulbar conjunctiva, running parallel to lower eyelid margin

to reduce false positives, LIPCOF need to be assessed in

• primary gaze

• absence of fluorescein (highlight microfolds leading to misclassification

treatment/management of LIPCOF

• tx of dry eye w/ palliative measures (PFATS)

• reduction of mechanical friction in CL wearers (re-evaluate lens fit & movement, etc.)

conjunctivochalasis

one or more folds of redundant, loose, & non-edematous bulbar conjunctiva that bulge over lower eyelid margin

pathogenesis of conjunctivochalasis

• repeated friction of eyelids against conjunctiva

• resultant degradation of conjunctival elastic fibers

• resultant characteristics “lid parallel” conjunctival folds coupled w/ loose conjunctiva

signs of conjunctivochalasis

• conjunctiva: localized areas of injection, redundant bulbar conjunctiva, early cases primarily temporal involvement, advanced cases diffuse involvement, may notice excessive movement w/ blinking

• tear film: increased tear meniscus, abnormal dispersion

treatment/management of conjunctivochalasis

• asymptomatic → observe

• mild/moderate symptoms → topical intervention to suppress ocular inflammation (PFATS, soft steroids, immunomodulators) or surgical intervention

lagophthalmos

inability to completely close the eyelids, resulting in persistent gap between upper & lower eyelids

lagopthalmos may occur during

• voluntary closure (voluntary lagopthalmos)

• normal blinking (incomplete blinking)

• sleep (nocturnal lagophthalmos)

• forecful closure

exposure keratopathy

damage of corneal epithelium secondary to prolonged subjection to air & other environmental factors

desiccation

drying & dehydration of conjunctival epithelium caused by inadequate tear film-coverage or excessive tear evaporation

treatment/management of exposure keratopathy

• lubrication

• increase ocular-surface humidity

• topical anti-inflammatories

• address tear retention

• optimize eyelid closure

• suture less amniotic membranes in cases of recalcitrant or severe epithelial compromise

pannus

superficial vascularization & scarring of peripheral cornea due to inflammatory process

signs of pannus

cornea has a combination of corneal vascularization or corneal opacification

micropannus

1-2mm

gross pannus

>2mm

treatment/management of pannus

dependent on adequate treatment of underlying etiology