Lid-parallel conjunctival folds (LIPCOF) and conjunctivochalasis (CCH) are similar conditions that are related to dry eye disease (DED), suggesting different management approaches. |
Tear substitutes, vectored thermal pulsation, microblepharoexfoliation, and fitting contact lenses with low coefficient of friction seem to reduce and prevent lid-parallel conjunctival folds. |
High-frequency radiowave electrosurgery seems to be a promising treatment for the complete elimination of conjunctivochalasis, avoiding the postoperative complications of traditional surgical techniques. |
Differentiation between LIPCOF and CCH is important, and it should be considered by practitioners in managing dry eye symptoms. |
Introduction
Methods
Data Sources and Search Strategy
Study Selection
Results and Discussion
Relationship Between LIPCOF and Dry Eye Symptoms in Non-CL and CL Wearers
Authors (date) | Country | Purpose | Design | Population | Age (years) | Eyes | Summary points |
---|---|---|---|---|---|---|---|
Pult et al. [20] (2008) | Germany | To investigate the predictive value of LIPCOF and LWE as objective measures of discomfort, and its relation to the ocular surface | Monocentric Case series | CLW | 32 [18 to 55] | 61 | LIPCOF and LWE were significantly more pronounced in CLW with dry eye symptoms. LIPCOF and LWE are significantly correlated. However, LIPCOF Sum severity scores appear to be most predictive for dry eye symptoms |
Pult et al. [7] (2009) | Germany | To investigated whether a combination of LIPCOF and LWE plus other tear film tests was better able to predict dry eye symptoms | Monocentric Case series | CLW | 31 [19 to 44] | 33 | LIPCOF, NIBUT, and OSDI were significant discriminators for dry eye symptoms in CLW compared to other tear film tests. The best test combination was NIBUT plus LIPCOF Sum and OSDI |
Pult et al. [27] (2011) | Germany | To evaluate the relationship between traditional tests, LWE, LIPCOF, and dry eye symptoms | Monocentric Case series | Non-CLW | 35 [19 to 70] | 47 | LIPCOF, NIBUT, TMH, and LWE were significantly correlated with dry eye symptoms. The strongest relationship appeared by combining NIBUT with nasal LIPCOF |
Veres et al. [6] (2011) | Hungary | To analyze the morphologic appearance of LIPCOF by OCT and relate it to dry eye symptoms and signs | Monocentric Case–control | Non-CLW | 50 [20 to 89] | 100 | LIPCOF were significantly more pronounced in the dry eye group compared to healthy controls. LIPCOF severity was significantly correlated with dry eye symptom severity |
Németh et al. [10] (2012) | Hungary | To assess the clinical application of LIPCOF grade as a diagnostic test for dry eye | Multicenter Case series | Non-CLW | 52.7 ± 16.2 | 272 | LIPCOF grade showed a significant correlation with the overall subjective symptoms. The sensitivity and specificity of LIPCOF grading for discriminating between normal and dry eyes were best with the cutoff between LIPCOF grade 1 and 2 |
Pult et al. [3] (2013) | Germany | To investigate the relationship between LIPCOF, blink action, and dry eye symptoms | Monocentric Case series | Non-CLW | 42.4 ± 12.3 | 60 | LIPCOF were significantly more pronounced in individuals with dry eye symptoms compared to those without dry eye symptoms. Blinking frequency and amplitude were significantly lower in the dry eye group |
Pult et al. [27] (2018) | Germany | To investigated the sensitivity and specificity of LIPCOF to predict dry eye | Monocentric Case series | Non-CLW | 37.0 ± 12.9 | 148 | LIPCOF demonstrated high predictive ability of dry eye with sensitivity and specificity values of 83.6% and 54.8%, respectively |
Siddireddy et al. [23] (2018) | Australia | To evaluate the potential of eyelid and tear film parameters as predictive factors for diagnosing dry eye symptoms | Monocentric Case series | CLW | 23 [18–41] | 30 | LIPCOF, palpebral conjunctival health, tear evaporation rate, and clinical signs related to meibomian gland secretions and morphology may be useful in predicting dry eye symptoms in CLW |
DED Management in Non-CL and CL Wearers with LIPCOF
Soft Contact Lens-Related Design, Material, and Fitting Characteristics
Authors (date) | Country | Purpose | Design | F/U (months) | Population | Age (years) | Eyes | Summary points |
---|---|---|---|---|---|---|---|---|
Related to CL | ||||||||
Pult et al. [26] (2019) | Germany | To investigate the impact of CL on LIPCOF | Randomized Controlled Masked | 3 | CLW | 35 [NR] | 60 | Refitting with senofilcon A daily wear silicone hydrogel lenses or discontinuing lens wear may be effective treatments for improving LIPCOF, LWE, and dry eye symptoms in experienced CLW |
Tear substitutes | ||||||||
Essa et al. [37] (2017) | England | To evaluate the effects of four preservative-free AT on DED | Monocentric Randomized Masked Crossover | 1 | Non-CLW | 61 ± 14.2 | 100 | LIPCOF grade was significantly decreased from 1.6 ± 0.8 to 1.3 ± 0.8 after applying these ATs 2.4 ± 1.5 times a day. OSDI and CFS also showed a significant improvement |
Eyelid treatments | ||||||||
Finis et al. [40] (2014) | Germany | To evaluate the effectiveness of a single VTP session versus eyelid warming on MGD | Monocentric Randomized Masked Crossover | 3 | Non-CLW | 50 ± 19 | 62 | LIPCOF grade remained unchanged in both groups. OSDI achieved a significant improvement in VTP treatment group compared to eyelid warming group. MGS showed significant improvement in both groups |
Finis et al. [41] (2014) | Germany | To assess the effectiveness of a single VTP session on MGD | Monocentric Randomized Masked | 6 | Non-CLW | 50 ± 22 | 52 | LIPCOF grade was significantly decreased from 2.3 ± 1.1 to 2.0 ± 0.9. OSDI, LLT, MGS, and conjunctival hyperemia also achieved a significant improvement |
Blackie et al. [42] (2018) | Canada | To evaluate the effects of a single VTP session on MGD | Monocentric Randomized Controlled Unmasked | 3 | CLW | 42 ± 14.5 | 110 | LIPCOF grade achieved significant improvement of 0.5 points in the VTP treatment group compared to control group. OSDI, MGS, TBUT, and LWE also showed significant improvements in the VTP treatment group compared to control group |
Siddireddy et al. [48] (2019) | Australia | To assess the effects of MBE versus hypoallergenic foam cleanser | Monocentric Randomized Unmasked Crossover | 0.25 | CLW | 23 [18 to 41] | 60 | LIPCOF grade achieved significant improvement of 0.5 points in the MBE group compared to eyelid hygiene group. LWE, TBUT, and MGS also showed significant improvements |
Tear Substitutes
Vectored Thermal Pulsation
Microblepharoexfoliation
Relationship Between CCH and Dry Eye Symptoms in Non-CL and CL Wearers
Authors (date) | Country | Purpose | Design | Population | Age (years) | Eyes | Summary points |
---|---|---|---|---|---|---|---|
Mimura et al. [22] (2009) | Japan | To assess the incidence and severity of CCH in CLW, as well as to compare the severity of conjunctivochalasis between CLW and non-CLW | Monocentric Case–control | CLW Non-CLW | 29.3 ± 12.4 | 1106 | CCH prevalence increased with age in all groups. CCH grade was significantly higher in CL wearers than in non-CLW. RGP CLW also showed significant higher CCH grade compared to soft CLW |
Le et al. [50] (2014) | China | To investigate the impact of CCH on tear film, dry eye symptoms, and quality of life | Monocentric Cross-sectional Controlled | Non-CLW | 64 ± 11.9 | 360 | Patients with CCH showed higher tear film instability, dry eye symptoms, and impaired quality of life compared to healthy controls |
Chhadva et al. [28] (2015) | USA | To study the relationship between CCH and dry eye signs and symptoms | Monocentric Case–control | Non-CLW | 63 ± 9.2 | 96 | Patients with nasal CCH reported higher dry eye symptoms and impaired quality of life compared to patients with non-nasal CCH and non-CCH. Patients with nasal CCH also showed increased meibomian gland dropout and eyelid vasculature compared to patients with non-CCH |
Dalianis et al. [49] (2018) | Greece | To investigate the manifestation of dry eye symptoms in patients with CCH | Monocentric Case series | Non-CLW | 77 [49–85] | 60 | CCH severity significantly increases dry eye symptoms. TBUT is also significantly reduced according to CCH severity |
DED Management in Non-CL and CL Wearers with CCH
Authors (date) | Country | Purpose | Design | F/U (months) | Population | Age (years) | Eyes | Summary points |
---|---|---|---|---|---|---|---|---|
Medical | ||||||||
Kiss et al. [56] (2015) | Hungary | To assess the effects of isotonic glycerol and 0.015% SH-containing AT on CCH | Monocentric Cases series | 3 | Non-CLW | 64 ± 17.8 | 40 | CCH grade was significantly decreased from 2.9 ± 0.4 to 1.4 ± 0.6 after medical treatment. OSDI score, TBUT, and CFS also showed a significant improvement |
Cağlayan et al. [57] (2018) | Turkey | To evaluate the effectiveness of combining topical 0.5% ketorolac tromethamine and 0.15% SH on CCH | Monocentric Case series | 1 | Non-CLW | 59 ± 8.10 | 20 | CCH area did not change significantly after medical treatment. OSDI score was the only variable that showed significant improvement |
Surgical | ||||||||
Chan et al. [59] (2015) | China | To assess the changes in tear film after conjunctival cauterization for CCH | Monocentric Case series | 1 | Non-CLW | 68.6 ± 10.9 | 36 | CCH was completely resolved in 80.6% of the cases. OSDI score and LLT also showed significant improvements. No intraoperative or postoperative complications were reported |
Santiago et al. [60] (2017) | Canada | To evaluate the outcomes of conjunctival cauterization for CCH | Monocentric Case series | 1 | Non-CLW | 72 ± 8.67 | 32 | Conjunctival redundancy was absent in 87.5% of the cases. CDEA score also showed significant improvement. No intraoperative or postoperative complications were reported |
Doss et al. [58] (2012) | USA | To assess the effectiveness of surgical excision with subconjunctival injection of fibrin sealant for CCH | Monocentric Case series | 3 | Non-CLW | 76 ± 3.4 | 139 | Conjunctival redundancy was absent in all patients. OSDI score also showed significant improvement. No significant complications were reported |
Santiago et al. [60] (2017) | Canada | To evaluate the outcomes of surgical excision for CCH | Monocentric Case series | 1 | Non-CLW | 72 ± 8.67 | 32 | CCH grade was significantly decreased from 2.0 ± 0.63 to 0.06 ± 0.25. CDEA score did not show significant improvement. No intraoperative or postoperative complications were reported |
Youm et al. [61] (2010) | South Korea | To assess the effectiveness of HFR-ES treatment on CCH | Monocentric Case series | 3 | Non-CLW | 68 ± 7.1 | 20 | CCH was completely resolved in 90% of the cases. OSDI score also showed significant improvement. Subconjunctival hemorrhage and chemosis were reported in 10% of the cases |
Trivli et al. [63] (2018) | Greece | To assess the effectiveness of HFR-ES treatment on CCH | Monocentric Case series | 8 | Non-CLW | 77 [49–85] | 40 | CCH was significantly reduced in all patients. Patients with CCH grade 1 showed significant improvement in dry eye symptoms compared to patients with CCH grade 2. Mild conjunctiva hyperemia was the main postoperative complication |
Ji et al. [62] (2021) | South Korea | To evaluate the effectiveness of HFR-ES treatment on CCH | Monocentric Case series | 1 | Non-CLW | 62 ± 12.4 | 40 | CCH was completely resolved in all patients. OSDI score, TBUT, CFS, and TMA showed significant improvements. However, MGD-related signs did not. No significant postoperative complications were reported |