What is the emergency department (ED) workup for a patient presenting with new onset chemosis (excessive swelling of the conjunctiva) that started in one eye within the last hour?

From the Guidelines

The emergency department (ED) workup for a patient presenting with new onset chemosis that started in one eye within the last hour should include a thorough history and physical examination to differentiate between infectious and noninfectious causes, with a focus on identifying potential viral or bacterial etiologies.

Key Components of the Workup

• History:
  • Ask about recent exposure to infected individuals, travel history, and any recent ocular trauma or surgery 1
  • Inquire about symptoms such as watery discharge, eyelid swelling, and erythema
• Physical Examination:
  • Assess for bulbar conjunctival injection, watery discharge, follicular reaction of inferior tarsal conjunctiva, chemosis, eyelid swelling, and erythema 1
  • Check for preauricular lymphadenopathy, which is often present in viral conjunctivitis 1
  • Perform a slit-lamp examination to identify membranes or pseudomembranes, corneal epithelial defects, dendrites, filaments, or infiltrates 1

Differential Diagnosis

• Viral Conjunctivitis:
  • Consider adenoviral conjunctivitis, which is highly contagious and can cause epidemic keratoconjunctivitis (EKC) 1
  • Herpes simplex virus (HSV) conjunctivitis is also a possibility, especially if the patient has a history of prior HSV infection 1
• Bacterial Conjunctivitis:
  • Although less likely, bacterial conjunctivitis should be considered, especially if the patient has a history of recent ocular trauma or surgery

Management

• Supportive Care:
  • Artificial tears, topical antihistamines, and cold compresses may be used to mitigate symptoms 1
  • Topical corticosteroids may be considered to reduce symptoms and scarring in severe cases, but close follow-up is warranted due to the potential for prolonged viral shedding 1
• Infection Control:
  • Educate the patient on measures to reduce the spread of infection, such as minimizing contact with others and practicing good hygiene 1

From the Research

Emergency Department Workup for New Onset Chemosis

The emergency department (ED) workup for a patient presenting with new onset chemosis that started in one eye within the last hour may involve the following steps:

• A thorough physical examination to identify any signs of orbital complications, such as cellulitis, ophthalmoplegia, and proptosis 2
• Imaging studies, such as orbital computerized tomography (CT) scan, to rule out underlying conditions like sinusitis or an intraorbital mass 2, 3
• Laboratory tests to evaluate for systemic conditions that may be causing the chemosis, such as allergic reactions or autoimmune disorders
• A review of the patient's medication history to identify potential causes of chemosis, such as amlodipine besylate (Norvasc) 4
• Consideration of rare genetic disorders, such as Fabry disease, in patients with chronic chemosis of unknown etiology 3

Potential Causes of Chemosis

Some potential causes of chemosis that should be considered in the ED workup include:

• Acute sinusitis, which can cause a conjunctival cyst-like lesion induced by severe chemosis 2
• Blepharoplasty surgery, which can lead to chemosis due to extravasation of fluid into the subconjunctival space 5
• Chronic localized conjunctival chemosis (CLCC), which may result from scarring and structural alteration of conjunctival lymphatics 6
• Medication side effects, such as those associated with amlodipine besylate (Norvasc) 4
• Rare genetic disorders, such as Fabry disease 3