[Column] Dry Eye Disease: If It Doesn’t Improve and Discomfort Persists, Consider “Conjunctivochalasis”

This column was written by Hyun Cheol Cheon, Chief Director of Bright Eye Clinic, Gangnam.

Recently, a male patient (48 years old, private academy instructor) visited our clinic for treatment. He reported that his eyes had gradually begun to feel irritated and dry. Because he had a history of dry eye disease, he initially did not consider the symptoms serious. However, the discomfort did not improve despite the use of artificial tears, and he later developed a persistent foreign body sensation and excessive tearing, which significantly interfered with his daily life. After examination, I diagnosed him with conjunctivochalasis, a condition that is often mistaken for dry eye disease.

Conjunctivochalasis is a disorder characterized by loosening and folding of the conjunctiva. It most commonly occurs as a result of aging, as the elasticity of the conjunctiva covering the eye decreases over time, and it therefore tends to affect individuals over the age of 40. However, recent years have seen an increasing number of cases among younger adults in their 20s and 30s, warranting greater attention. In addition to aging, various factors can contribute to the development of conjunctivochalasis, including long-term contact lens wear, conjunctival edema following cosmetic surgery, blepharitis, meibomian gland dysfunction, and habitual eye rubbing.

As in the case described above, many patients initially visit the clinic for symptoms of dry eye disease and are later diagnosed with conjunctivochalasis. The main symptoms of conjunctivochalasis include excessive tearing, a foreign body sensation, redness, ocular irritation, and a gritty or tight feeling in the eyes. Because these symptoms closely resemble those of dry eye disease, diagnosis and treatment are often delayed. The key difference between the two conditions lies in their underlying causes. In conjunctivochalasis, structural changes—namely conjunctival folds—directly lead to dry eye–like symptoms, whereas dry eye disease results from dysfunction of the tear film. The two conditions may also coexist, and because their treatment approaches differ, an accurate diagnosis by an ophthalmic specialist is essential.

Treatment for conjunctivochalasis is not as complicated as many patients might expect. Recently, a non-surgical treatment using a high-precision radiofrequency (RF) device called Acutron has been introduced, allowing for faster recovery. The procedure is brief and straightforward, typically taking around 10 minutes, and works by applying radiofrequency-generated heat to contract the loosened conjunctiva.

During the procedure, radiofrequency energy is delivered to the conjunctival tissue through a microneedle. Because RF energy has a strong affinity for water, the conjunctival cells readily absorb the energy. This process causes the redundant conjunctiva to contract, while simultaneous vaporization promotes tissue coagulation and accelerates healing.

Maintains a consistent and stable output at Level 2 for 30 minutes

The greatest advantage of this procedure is that it is non-invasive and incision-free, allowing treatment without scarring. No anesthesia or suturing is required during the procedure, and recovery is rapid enough that patients can return to daily activities immediately afterward.

In conclusion, conjunctivochalasis is not a condition that is difficult to treat when it is diagnosed early and managed appropriately. However, because its symptoms closely resemble those of dry eye disease, self-diagnosis can be challenging. For this reason, individuals experiencing persistent ocular discomfort—such as excessive tearing, a foreign body sensation, or dryness—are strongly advised to undergo a thorough ophthalmic evaluation.

In addition, even when the eyes feel uncomfortable, patients should avoid rubbing their eyes, as this can worsen symptoms. Those with preexisting dry eye disease should carefully monitor any changes or worsening of symptoms to ensure that other ocular conditions are not overlooked or left untreated.