What are the medications used to treat chemosis?

Medications for Chemosis Treatment

Topical adrenaline (epinephrine) 1:1000 is an effective treatment for severe tarsal conjunctival chemosis when other conservative therapies fail. 1

First-Line Treatments

Chemosis management follows a stepwise approach based on severity and duration:

• Lubricating eye drops and ointments are the initial treatment to maintain a moist ocular surface and reduce conjunctival dryness 2
• Topical antihistamines can be used for allergic causes of chemosis 1
• Topical steroids (such as prednisolone acetate or dexamethasone) help reduce inflammation and are particularly effective for inflammatory chemosis 2, 3
• Topical decongestants may help reduce fluid accumulation in the conjunctiva 3

Second-Line Treatments

For persistent or severe chemosis that doesn't respond to first-line therapy:

• Topical adrenaline (epinephrine) 1:1000 has shown rapid and lasting effects in severe refractory cases 1
• Oral antihistamines may be added for allergic causes 1
• Compression bandaging can be used for mechanical reduction of fluid 2, 3
• Eye patching may be necessary in cases with significant exposure 3

Treatment Algorithm Based on Chemosis Classification

Type 1: Acute Mild Chemosis with Complete Lid Closure

• Liberal lubrication with artificial tears and ointments 3
• Topical steroids if inflammation is present 3

Type 2: Acute Severe Chemosis with Lagophthalmos

• Aggressive lubrication 3
• Topical steroids 3
• Consider topical adrenaline 1:1000 1
• Eye patching if needed 3

Type 3: Subchronic Chemosis (>3 weeks)

• Continue lubrication and steroids 3
• Add topical decongestants 3
• Consider compression bandaging 2, 3

Type 4: Chemosis with Lower Lid Malposition

• Address underlying lid malposition 3
• Continue medical management as above 3

Surgical Interventions for Refractory Cases

For chemosis that persists despite medical management:

• Drainage conjunctivotomy - small incisions to drain accumulated fluid 3
• Temporary tarsorrhaphy may be necessary in severe cases 3

Special Considerations

• Chronic localized conjunctival chemosis (CLCC) that persists for ≥6 months may result from scarring and structural alteration of conjunctival lymphatics 4
• Biopsy may show chronic tissue inflammation or lymphangiectasia in persistent cases 4
• Post-blepharoplasty chemosis has a multifactorial etiology including exposure, periorbital edema, and lymphatic dysfunction 3

Prevention Strategies

• Minimize surgical exposure and manipulation during periocular procedures 2
• Maintain a moist ocular surface during surgery 2
• Address perioperative factors that may contribute to chemosis, such as excessive fluid administration or positioning 3