What are the treatment options for chemosis?

Treatment Options for Chemosis

Topical corticosteroids are the most effective first-line treatment for chemosis, especially in cases with marked chemosis, lid swelling, or epithelial sloughing. 1

First-Line Treatments

• Artificial tears/lubricants - Help reduce ocular surface dryness and provide symptomatic relief 1, 2
• Topical antihistamines - Effective for allergic causes of chemosis 3
• Topical corticosteroids - Reduce inflammation and are particularly helpful in severe cases with marked chemosis or lid swelling 1
• Cold compresses - Provide symptomatic relief by reducing edema and inflammation 2, 4

Second-Line Treatments

• Cromolyn sodium ophthalmic solution (4%) - Administer 1-2 drops in each eye 4-6 times daily at regular intervals; symptomatic improvement usually occurs within a few days, but treatment for up to 6 weeks may be required 5
• Compression bandaging - Helpful for persistent cases to reduce fluid accumulation 2
• Topical decongestants - Can reduce vascular congestion and edema 4

For Severe or Refractory Cases

• Topical adrenaline (1:1000) - Shown to be effective in severe refractory cases when other conservative therapies fail 3
• Drainage conjunctivotomy - Surgical drainage may be necessary for persistent chemosis 4
• Temporary tarsorrhaphy - Can be considered for chemosis-induced lagophthalmos (inability to close eyelids completely) 4

Treatment Algorithm Based on Severity

Mild Chemosis

1. Artificial tears/lubricants
2. Cold compresses
3. Topical antihistamines (if allergic etiology suspected)

Moderate Chemosis

1. All treatments for mild chemosis
2. Add topical corticosteroids
3. Add cromolyn sodium if allergic component is present

Severe Chemosis

1. All treatments for moderate chemosis
2. Consider topical adrenaline (1:1000) for refractory cases
3. Compression bandaging
4. Surgical interventions (drainage conjunctivotomy or temporary tarsorrhaphy) if conservative measures fail

Special Considerations

• Post-blepharoplasty chemosis requires a specific approach based on timing:

  • Early chemosis (first week): Aggressive lubrication and topical anti-inflammatories 6
  • Late chemosis (1-3 weeks): Add topical decongestants and consider compression 6
  • Prolonged chemosis (>3 weeks): Consider surgical interventions 6, 4

• Chronic localized conjunctival chemosis (CLCC) may be due to structural alterations in conjunctival lymphatics and may require biopsy to confirm diagnosis 7

Pitfalls and Caveats

• Prolonged use of topical corticosteroids requires monitoring for increased intraocular pressure and cataract formation 1
• When using topical adrenaline, be cautious of potential cardiovascular side effects 3
• Chemosis may be multifactorial, so addressing all potential causes is essential for effective management 4
• For adenoviral conjunctivitis with chemosis, be aware that corticosteroid use may prolong viral shedding (shown in animal models, though human evidence is inconclusive) 1