Chemosis

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What is Chemosis in the Eye?

When you have chemosis, the conjunctiva (outer layer of the eye) may look similar to a big blister. There may even be fluid inside. This eye condition can cause discomfort.

In more severe cases, chemosis can result in extreme tissue swelling that prevents the eyes from closing correctly. 

While the causes will vary, chemosis can become chronic. For this reason, it is important to see an eye care specialist or seek medical help to receive appropriate treatment. 

What Causes Chemosis?

Many different causes can lead to chemosis. The following list details causes of chemosis below:

  • Angioedema (the rapid swelling of the mucosa)
  • Allergic reaction
  • Bacterial infection 
  • Viral infection 
  • Orbital (eye socket area) inflammation due to trauma, eye injury, or Graves disease
  • Obstructed lymphatic and venous outflow (drainage)
  • Rubbing eyes 
  • Thyroid issues, such as hyperthyroidism 

Chemosis can appear after surgical procedures are performed on or around the eye. For example, there have been cases of chemosis in people who underwent blepharoplasty (to repair droopy eyelids). Canthal surgery (to improve the shape of the eyelids) has also been suggested to cause chemosis. 

Is Chemosis a Serious Condition?

Chemosis may become a serious condition if it prevents you from closing your eyes properly. If left untreated, there may even be irreversible chronic chemosis. 

Also, chemosis can occur because of different health issues. If you have chemosis, it may indicate an underlying viral or bacterial infection. 

Some infections can place your health at further risk if you do not receive the necessary treatment. 

What are the Symptoms of Chemosis?

When you suffer from chemosis, the membrane lining your eyes and eyelids builds up fluid. Because of this, you can experience symptoms such as:

  • Watery eyes
  • Excessive tearing 
  • Redness, eye irritation, or itchiness
  • Diplopia (double vision)
  • Blurred vision 
  • Foreign body sensation

The conjunctival edema (swelling) may become so intense that you cannot close the affected eye completely. 

If you experience eye pain or have accompanying symptoms of a severe allergic reaction, seek medical care immediately. Symptoms of a severe allergic reaction are as follows:

  • Trouble breathing 
  • Change in heart rate 
  • Wheezing 
  • Swelling of the lips or tongue 

Conjunctival Chemosis vs. Conjunctivitis (Pink Eye)

When you have conjunctival chemosis, you may confuse it with conjunctivitis (otherwise known as pink eye). Both conjunctivitis and chemosis affect the conjunctiva. Also, chemosis and conjunctivitis can occur either simultaneously or because of the same cause. 

However, there is a difference. 

Chemosis describes a swelling of the conjunctiva. Conjunctivitis is an inflammation of the thin eye membrane. 

An individual may develop both chemosis and conjunctivitis at the same time and in one or both eyes. 

Who is at Risk of Developing Chemosis?

Chemosis can occur in any person. However, some people may have an increased risk of developing an eye condition. 

For example, if you suffer from allergies or rub your eye infrequently, you raise the likelihood of chemosis. 

Also, people who wear contact lenses or eye make-up have a higher risk of eye infections that eventually lead to chemosis.  

Finally, if you’re considering undergoing a surgical procedure, like blepharoplasty, your risk increases if you have the following:

  • Pre-existing ocular surface disorders
  • Conjunctivochalasis (excess folds of the conjunctiva between the globe of the eye and eyelid margins)
  • Poor eyelid closure mechanics
  • Lower eyelid laxity (loose eyelids)

According to the Centers for Disease Control and Prevention, approximately 40 to 90 percent of people who wear contact lenses do not adequately adhere to care instructions for their contact lenses.

How Can You Prevent Chemosis From Happening?

Chemosis is preventable in some cases, depending on the underlying cause. For example, if you have allergies, you may want to take antihistamines or speak to an allergy specialist about daily treatment. 

Also, because bacterial and viral infections can cause chemosis, it is important to wash your hands thoroughly to prevent introducing harmful microbes into the eye. You’re also recommended to minimize touching or rubbing your eyes and practice good hygiene.  

Nonetheless, you may not be able to prevent chemosis after undergoing an eye surgery. You can speak to your eye surgeon to see if treatment is available to minimize your risk of post-surgical eye complications. 

How is Chemosis Diagnosed?

If you believe you have chemosis, you should consult an ophthalmologist, optometrist, or healthcare professional. 

Your specialist will perform a proper examination of the affected eye and ask you about your symptoms. Depending on your responses and case severity, your specialist should be able to offer you a suitable treatment. 

How to Manage Chemosis At Home

If you have chemosis, it is important to follow good care practices. This may include:

  • Taking antibiotics 
  • Administering eye lubricant drops 
  • Wearing a pressure eye patch 
  • Placing cool compresses over the eye 

You must consult your healthcare specialist to determine the best treatment for you. Because there are multiple causes for chemosis, treatments will vary. 

A temporary low-carbohydrate diet that reduces carbs to no more than 20% of caloric intake can help with swelling. Before making any changes to your diet, you should consult your healthcare provider or a registered nutritionist/dietician.  

Chemosis Treatment Options

Antibiotics

Your eye care specialist may recommend antibiotic eye drops to treat an underlying bacterial infection. Antibiotic eye drops will not treat viral infections. 

Antihistamines

If you have chemosis or symptoms associated with allergies, you may consider over-the-counter antihistamines and cool compresses placed on the closed eyes.  

Eye Surgery

In more severe cases of chemosis, eye surgery is necessary. When this happens, an eye surgeon will make an incision in the chemotic blister to release liquid. The surgeon may also apply a mild-pressure eyelid bandage to compress the conjunctiva. 

Eye Drops

Your eye care specialist may prescribe ocular lubricants or eye drops to reduce inflammation and prevent other eye issues. 

Chemosis: Common Questions and Answers

When should I see a doctor?

You should speak with your healthcare provider if your symptoms have not gone away; you have trouble closing your eye completely; or you’re experiencing other symptoms like difficulty breathing or fainting. 

How is chemosis diagnosed?

Your eye care specialist will examine your eye and ask you to describe all of your symptoms. Because the cause of chemosis will vary, your doctor will determine the diagnosis based on your report. 

How long does chemosis last?

Chemosis can last a few days, a few weeks, or even months, depending on the cause. Also, chemosis can become chronic if not treated properly. 

How common is chemosis in the eye? 

Chemosis can happen in any person. Many times, people will confuse it with conjunctivitis because of similarities. However, chemosis refers to a swelling of the conjunctiva. 

Can dry eyes cause chemosis? 

Yes. Dry eyes could cause chemosis or even increase chemosis severity. 

Is chemosis permanent?

In many cases, chemosis resolves with treatment. However, in some instances, chemosis can become chronic.  

Can chemosis damage eye health?

If you do not receive treatment for chemosis, the condition can cause other eye health problems. For example, chemosis can become chronic or cause adjacent corneal changes like exposure keratitis or dellen formation (saucer-like thinnings).

Resources
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“Chemosis.” Chemosis | Columbia Ophthalmology, www.columbiaeye.org/education/digital-reference-of-ophthalmology/cornea-external-diseases/non-infectious/chemosis.

“Chemosis: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/003038.htm.

Clinton D. McCord, MD, Peter Kreymerman, MD, Foad Nahai, MD, Joseph D. Walrath, MD, Management of Postblepharoplasty Chemosis, Aesthetic Surgery Journal, Volume 33, Issue 5, July 2013, Pages 654–661, https://doi.org/10.1177/1090820X13487016.

“Dry Eye Symptoms and Chemosis Appear Common Following Blepharoplasty.” American Academy of Ophthalmology, 24 Apr. 2013, www.aao.org/editors-choice/dry-eye-symptoms-chemosis-appear-common-following-.

“Fast Facts.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 26 July 2018, www.cdc.gov/contactlenses/fast-facts.html.

Kim, Kyeong Hwan, and Wan Soo Kim. “Chronic Unilateral Chemosis Following the Use of Amlodipine Besylate.” BMC Ophthalmology, BioMed Central, 21 Oct. 2014, bmcophthalmol.biomedcentral.com/articles/10.1186/1471-2415-14-124.

Minckler, Michael R, et al. “Chemosis from Trauma.” The Western Journal of Emergency Medicine, Department of Emergency Medicine, University of California, Irvine School of Medicine, July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4100827/.

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