From the Guidelines
Chemosis in a patient with a red eye is a clinically significant sign that often indicates severe ocular surface inflammation or increased vascular permeability, requiring prompt evaluation and treatment to prevent potential complications such as conjunctival scarring, symblepharon, keratitis, and subepithelial corneal infiltrates. The presence of chemosis can be a sign of serious conditions including severe allergic reactions, infectious conjunctivitis, orbital cellulitis, cavernous sinus thrombosis, or thyroid eye disease 1. When evaluating a patient with chemosis, it's essential to determine the underlying cause through a complete eye examination, including visual acuity testing and intraocular pressure measurement.
Some key points to consider in the evaluation and management of chemosis include:
- The use of topical corticosteroids to reduce symptoms and prevent scarring in severe cases of adenoviral keratoconjunctivitis with marked chemosis or lid swelling, epithelial sloughing, or membranous conjunctivitis 1
- The potential benefits and risks of using povidone-iodine as a treatment consideration for conjunctivitis, including its broad antimicrobial spectrum and potential to reduce viral titers and preserve visual function 1
- The importance of close follow-up for patients with adenoviral conjunctivitis who are being treated with corticosteroids, including monitoring for signs of orbital involvement and potential complications such as glaucoma and cataract 1
Treatment depends on the etiology, and may include:
- Allergic reactions: antihistamines like olopatadine 0.1% drops twice daily or artificial tears for lubrication
- Infectious causes: antibiotics such as moxifloxacin 0.5% drops every 3-4 hours
- Inflammatory conditions: topical steroids like prednisolone acetate 1% four times daily Severe chemosis with signs of orbital involvement (decreased vision, limited eye movement, proptosis) constitutes an emergency requiring immediate referral to ophthalmology 1. Chemosis occurs because inflammatory mediators increase blood vessel permeability, allowing fluid to leak into the conjunctival tissue, creating the characteristic gelatinous appearance of the swollen conjunctiva.
From the Research
Clinical Significance of Chemosis in Red Eye
The clinical significance of chemosis in a patient with a red eye can be understood by considering the various causes and implications of this condition.
- Chemosis, which refers to the swelling of the conjunctiva, can be a symptom of several ocular conditions, including conjunctivitis, blepharitis, and acute angle-closure glaucoma 2, 3, 4, 5.
- In the context of red eye, chemosis may indicate a more severe underlying condition, such as acute angle-closure glaucoma, which requires immediate medical attention 4, 5.
- The presence of chemosis, along with other symptoms like severe ocular pain, significant photophobia, and decreased vision, can be a warning sign for a true ocular emergency that demands immediate ophthalmological consultation 3.
- Chemosis can also be a complication of surgical procedures, such as blepharoplasty, and can be managed with a stepwise approach, including lubricants, anti-inflammatories, and compression bandaging 6.
- A comprehensive assessment of red eye conditions, including chemosis, is essential to preserve the patient's visual function and prevent severe complications 3.
Key Considerations
- Recognizing the need for emergent referral to an ophthalmologist is crucial in the primary care management of red eye, especially when chemosis is present 2, 3, 5.
- A detailed patient history and careful eye examination are necessary to diagnose the underlying cause of chemosis and red eye, and to guide treatment decisions 2, 3, 5.