Purpose <p>To investigate the association between the anatomical location of conjunctivochalasis (CCh) and subjective chief complaints in patients who underwent surgical treatment.</p> Study design <p>Retrospective multicenter study</p> Methods <p>This study included 39 eyes of 27 patients undergoing surgery for symptomatic CCh. CCh location was classified as total, nasal, nasal-plus-temporal, or temporal; chief complaints were registered as discomfort/foreign body sensation (FBS), epiphora, or cosmetic complaint. Associations were evaluated by Chi-square test (Cramér’s V) and pairwise Fisher’s exact tests; age differences by Kruskal–Wallis test.</p> Results <p>A significant association was found between CCh location and chief complaint (χ² = 35.48, <i>P</i> = 0.000003; Cramér’s V = 0.674). Total CCh was predominantly associated with discomfort/FBS (<i>P</i> = 0.0038). Nasal CCh showed a predominant pattern of epiphora. Nasal-plus-temporal CCh showed a mixed pattern, epiphora and discomfort/FBS. Temporal CCh was observed predominantly&#xa0;with cosmetic complaints (<i>P</i> &lt; 0.001). Patients with cosmetic complaints were significantly younger than those in other symptom groups (<i>P</i> = 0.0003).</p> Conclusion <p>In this surgically selected cohort, subjective symptoms were significantly associated with CCh location. Total CCh was associated with discomfort/FBS, nasal CCh with epiphora, and temporal CCh with cosmetic complaints. The combination of CCh location and patient age may further clarify the clinical presentation: older patients with total CCh sought surgery for mechanical irritation, while younger patients with temporal CCh sought surgery for cosmetic reasons. Recognizing this location- and age-based pattern may help clinicians anticipate the chief complaint and support individualized surgical decision-making.</p>