What is the clinical significance of chemosis in a patient with a red eye?

From the Guidelines

Chemosis in a patient with a red eye is a clinically significant finding that often indicates severe ocular surface inflammation or increased vascular permeability, requiring prompt evaluation and potentially indicating serious conditions such as allergic conjunctivitis, infectious conjunctivitis, or orbital cellulitis. The presence of chemosis, characterized by the swelling of the conjunctiva, can be a sign of various conditions, including viral conjunctivitis, which may present with abrupt onset, unilateral or bilateral involvement, and distinctive signs such as preauricular lymphadenopathy and petechial hemorrhages 1.

Clinical Significance of Chemosis

• Chemosis can be a sign of serious conditions, including allergic conjunctivitis, infectious conjunctivitis, orbital cellulitis, carotid-cavernous fistula, or thyroid eye disease
• Severe chemosis with signs of orbital involvement, such as restricted eye movement, proptosis, or vision loss, warrants emergency referral and possibly IV antibiotics
• The presence of chemosis reflects inflammatory mediators causing increased vascular permeability and fluid accumulation in the conjunctival tissue, creating a characteristic gelatinous appearance

Management of Chemosis

• Management depends on the underlying cause, with allergic chemosis potentially responding to topical antihistamines like olopatadine 0.1% twice daily or artificial tears for lubrication
• Infectious causes may require topical antibiotics, such as moxifloxacin 0.5% every 3-4 hours, and severe cases may necessitate emergency referral and IV antibiotics
• Topical corticosteroids, such as those used in the treatment of adenoviral keratoconjunctivitis, may be helpful in reducing symptoms and scarring, but their use requires close follow-up to monitor for potential adverse effects, such as prolonged viral shedding 1

Key Considerations

• Chemosis should never be dismissed in the context of a red eye, as it may be the first sign of a vision-threatening process
• A thorough evaluation, including a detailed history and slit-lamp biomicroscopy, is essential to determine the underlying cause of chemosis and guide management
• Patients with severe disease or those who are prescribed prolonged topical corticosteroids should be monitored closely for potential complications, such as glaucoma or cataract 1

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 manifestations of red eye.

• 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 the presence of an underlying inflammatory or infectious process, and its severity can help guide the diagnosis and treatment plan 2, 3.
• For example, in cases of acute angle-closure glaucoma, chemosis can be a significant finding, as it may indicate increased intraocular pressure and the need for urgent ophthalmic evaluation and treatment 4, 5.
• In other cases, such as blepharoplasty surgery, chemosis can be a common complication, and its management may involve a stepwise approach with lubricants, anti-inflammatories, and compression bandaging 6.
• The presence of chemosis in a patient with red eye should prompt a detailed history, baseline ophthalmological tests, and accompanying manifestations to narrow down the differential diagnosis and guide further management 2, 3.

Diagnostic Considerations

• A correct assessment of the urgency of the situation is vital for planning further diagnostic evaluation and treatment, and the presence of chemosis can help inform this assessment 3.
• The duration and laterality of symptoms, as well as the intensity of pain, are key criteria for differentiating non-critical changes from diseases requiring urgent ophthalmic attention 3.
• In cases where the diagnosis is uncertain or the patient presents with severe symptoms, such as vision loss or copious purulent discharge, urgent referral to an ophthalmologist is necessary 2, 3, 5.