What is the treatment for chemosis?

Treatment of Chemosis

The treatment of chemosis should begin with lubricating eye drops (nonpreserved hyaluronate or carmellose) applied every two hours to maintain ocular surface lubrication, followed by topical corticosteroids if the chemosis is severe or persistent. 1

Understanding Chemosis

Chemosis is the swelling or edema of the conjunctiva due to fluid accumulation in the subconjunctival space, presenting as a gelatinous or watery bulging of the conjunctiva that may range from mild to severe. 2

Common Causes of Chemosis:

• Viral conjunctivitis - often accompanied by watery discharge and preauricular lymphadenopathy 2
• Allergic reactions - typically with itching and watery discharge 2
• Bacterial conjunctivitis - presents with purulent discharge 2
• Thyroid eye disease - associated with upper-eyelid laxity and eyelid imbrication 2
• Post-surgical complication - particularly after blepharoplasty 3, 4
• Medication-induced - especially from preservatives in eye drops 2
• Contact lens wear - from mechanical irritation or hypersensitivity 2

Treatment Algorithm for Chemosis

First-Line Treatment:

• Apply nonpreserved lubricating eye drops (hyaluronate or carmellose) every two hours 1
• Perform ocular hygiene to remove inflammatory debris using saline irrigation 1
• Use cold compresses to reduce swelling and inflammation 1

For Moderate to Severe Chemosis:

• Add topical corticosteroids to reduce inflammation and symptoms 1
• Use with caution if corneal epithelial defects are present 1
• Consider topical antihistamines for allergic causes 1

For Severe, Refractory Cases:

• Consider topical adrenaline (1:1000) when other conservative therapies fail 5
• For post-surgical chemosis, eye patching may be beneficial 4
• In extreme cases, drainage conjunctivotomy or temporary tarsorrhaphy may be necessary 4

For Chemosis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis:

• Daily ophthalmological review is necessary during the acute illness 1
• Ocular hygiene must be performed daily by an ophthalmologist or ophthalmically trained nurse 1
• Break down conjunctival adhesions using a squint hook and forceps 1

Special Considerations

Post-Blepharoplasty Chemosis:

• Implement a stepwise approach starting with lubricants 3
• Escalate to increasingly potent anti-inflammatories if needed 3
• Use compression bandaging for persistent cases 3
• Surgical intervention should be reserved for cases that don't respond to medical management 3, 4

Chronic Localized Conjunctival Chemosis:

• May persist for 6+ months due to scarring and structural alteration of conjunctival lymphatics 6
• Often requires long-term management as it may be irreversible 6

Congenital Eyelid Eversion with Chemosis:

• Conservative management with topical lubrication and antibiotics is typically effective 7

Monitoring and Follow-up

• Patients with severe chemosis should be evaluated by an ophthalmologist 1
• Acute chemosis typically resolves within days to weeks 2
• For patients on prolonged topical corticosteroids, monitor intraocular pressure and pupillary dilation to evaluate for glaucoma and cataract 1
• Taper corticosteroids once inflammation is controlled 1

Common Pitfalls and Caveats

• Avoid blind sweeping of the fornices with a cotton bud or glass rod as this may potentially cause damage 1
• Use topical corticosteroids with caution in the presence of corneal epithelial defects 1
• Avoid antibiotics for viral causes as they provide no benefit and may cause adverse effects 1
• For post-surgical chemosis, prevention is key by minimizing surgical exposure and maintaining a moist ocular surface intraoperatively 3