From the Guidelines
The treatment of chemosis should be directed at the underlying cause, with a focus on reducing inflammation and fluid accumulation, as evidenced by the most recent conjunctivitis preferred practice pattern 1. The treatment approach depends on the specific cause of chemosis, which can be allergic, infectious, or traumatic.
- For allergic chemosis, first-line treatment includes artificial tears for lubrication and cold compresses to reduce swelling, as well as antihistamine eye drops like olopatadine (Patanol) or ketotifen (Zaditor) used 1-2 times daily.
- For infectious causes, such as gonococcal or chlamydial conjunctivitis, appropriate antibiotics or antivirals are needed, as outlined in the conjunctivitis preferred practice pattern 1.
- For cases resulting from trauma or surgery, conservative management with lubricants and elevation of the head while sleeping is often sufficient, but severe cases may require temporary tarsorrhaphy (partial surgical closure of the eyelids) to protect the cornea. It is essential to note that topical corticosteroids can be helpful in reducing symptoms and scarring in severe cases of adenoviral keratoconjunctivitis with marked chemosis or lid swelling, but their use should be carefully monitored due to potential adverse effects, as highlighted in the conjunctivitis preferred practice pattern 1. In all cases, treatment aims to reduce inflammation and fluid accumulation while addressing the specific trigger that initiated the response, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Treatment of Chemosis
The treatment of chemosis, a common complication of blepharoplasty, can be managed through various approaches.
- Intraoperative measures to minimize surgical exposure and manipulation, as well as maintaining a moist ocular surface, can reduce the risks of chemosis 2.
- Postoperative treatment may involve a stepwise approach, starting with lubricants and escalating to increasingly potent anti-inflammatories, with compression bandaging and surgery reserved for persistent cases 2.
- A classification system for chemosis has been proposed, with four general patterns of presentation: type 1, acute mild chemosis; type 2, acute severe chemosis; type 3, subchronic chemosis; and type 4, chemosis associated with lower lid malposition 3.
- Treatment options may include liberal lubrication, ophthalmic steroid preparations, ocular decongestants, eye-patching, and minor surgical procedures such as drainage conjunctivotomy and temporary tarsorrhaphy 3.
- In some cases, chemosis may resolve spontaneously, but treatment with patching, topical and/or systemic steroids, decongestant eye drops, and observation may be necessary 4, 5.
Causes of Chemosis
The causes of chemosis are multifactorial and may include:
- Exposure, periorbital edema, and postoperative lymphatic dysfunction 3.
- Blockage of orbital or eyelid lymphatics and excessive cautery during surgery 4.
- Delayed sequelae of surgery and/or radiation in patients with a history of head or neck tumors 6.
Management of Chemosis
The management of chemosis requires a comprehensive approach, taking into account the underlying causes and the severity of the condition.