Management of Chemosis
The initial approach to treating chemosis should begin with topical lubricants and anti-inflammatory medications, with treatment escalation based on severity and persistence of symptoms. 1
Understanding Chemosis
Chemosis is the swelling of the conjunctiva due to fluid accumulation in the subconjunctival space. It can occur due to various causes:
- Inflammation, surgical manipulation, and disruption of lymphatic drainage are common mechanisms 1
- Extravasation of fluid into the subconjunctival space can be precipitated by desiccation, inflammation, and manipulation of the conjunctiva 1
- In chronic cases, scarring and structural alteration of conjunctival lymphatics may lead to persistent chemosis 2
Classification of Chemosis
Chemosis can be classified based on severity and presentation:
- Type 1: Acute mild chemosis with complete lid closure 3
- Type 2: Acute severe chemosis that prohibits complete lid closure (chemosis-induced lagophthalmos) 3
- Type 3: Subchronic chemosis that persists longer than 3 weeks 3
- Type 4: Chemosis associated with lower lid malposition 3
Stepwise Treatment Approach
First-Line Treatment
- Topical lubricants (artificial tears) to maintain ocular surface moisture 1, 3
- Topical anti-inflammatory medications such as steroid eye drops to reduce inflammation 1, 3
- Ocular decongestants to reduce fluid accumulation 3
- Cold compresses to reduce swelling 3
Second-Line Treatment
- Topical adrenaline (1:1000) can be effective when other conservative therapies fail, especially in severe cases 4
- Compression bandaging to reduce fluid accumulation 1
- Eye-patching for more severe cases to protect the ocular surface 3
Third-Line Treatment
- Drainage conjunctivotomy for persistent cases 3
- Temporary tarsorrhaphy may be required for severe cases with lagophthalmos 3
Special Considerations
Postoperative Chemosis
- Particularly common after lower blepharoplasty (reported incidence of 11.5%) 3
- Intraoperative prevention includes minimizing surgical exposure and manipulation 1
- Maintaining a moist ocular surface during surgery can reduce risk 1
Chronic Localized Conjunctival Chemosis (CLCC)
- Diagnosed when localized conjunctival edema persists for 6 months or longer 2
- May require biopsy to rule out other causes 2
- Often shows chronic tissue inflammation or lymphangiectasia on histological examination 2
Chemosis in Allergic Reactions
- May require additional antihistamine therapy (topical or oral) 4
- In severe allergic cases, consider systemic steroids if topical treatments are ineffective 4
Treatment Duration and Prognosis
- Most cases of acute chemosis resolve within 1-4 weeks with appropriate treatment 3
- More severe or chronic cases may take up to 12 weeks to resolve completely 3
- With appropriate management, all cases ultimately resolve, though chronic cases may require longer and more aggressive treatment 3