All about Conjunctival Chemosis »
What is conjunctival chemosis?
Conjunctival chemosis is the jelly-like swelling (edema) of the conjunctiva – the outer transparent covering of the inner part of the eyelid (tarsal conjunctiva), and the covering of sclera (bulbar conjunctiva). The sclera is the white part of the eye. This swelling of the conjunctiva occurs due to the oozing of exudates by the highly permeable capillaries.
Chemosis of the conjunctiva is the sign of irritation and inflammation of the eye. Most of the time, chemosis appears in a small area on the outer corner (lateral canthal area) of the eye. Occasionally, the whole of the conjunctiva looks like a big blister due to the accumulation of exudates.
In a severe form of chemosis, the tissue swelling is so intense that the patient is unable to close his eyes properly. The central black part of the eyeball appears to move slightly inwards as the iris is not covered by fluid.
Although you can’t catch it from another person (not contagious), a chemosis is a nuisance for the affected person, as the eyes may swell so much that patients can’t close their eyes properly.
Acute conjunctival chemosis is often associated with hypersensitivity response to eye allergens (e.g. pollen), but can also occur in severe eye infections, eye surgery, or constant eye rubbing. Subacute or chronic chemosis has numerous causes.
Classification of Chemosis
It can be classified based on the severity of conjunctival inflammation, but in general, it is most useful to classify the condition by degree of conjunctival prolapse between the eyelid margins, as follows:
In mild form, there is the presence of only a slight, “billowing” seen in the conjunctiva, with slight conjunctival protrusion.
There is a presence of a more pronounced conjunctival prolapse, but the eyelids can still be closed over the protruding conjunctiva.
In severe form, there is the presence of conjunctival prolapse to the degree that it impairs eyelid closure or the ability of the eyelids to cover the cornea, even during manual attempts at closure.
Causes of conjunctival chemosis
As prevention is the best and most effective treatment measure against chemosis, understanding the underlying causes of it helps patients avoid the condition themselves. The following are the common causes of conjunctival chemosis.
The primary cause of chemosis is ocular irritation. Obviously, there are several means by which one of the most sensitive organs of the body (eye) can become irritated. Certain allergens, for example, can make the eyes itchy, appear red, swollen, and watery. This condition is known as allergic conjunctivitis. Allergens such as animal dander and pollen dust can lead to chemosis of conjunctiva. So, allergens can cause both allergic conjunctivitis and chemosis.
Inflammatory conditions in and around the eyeball such as conjunctivitis, corneal ulcers, fulminating iridocyclitis, endophthalmitis, panophthalmitis, styes, acute meibomitis, orbital cellulitis, acute dacryoadenitis, acute dacryocystitis, tenonitis, etc. can cause conjunctival chemosis.
Local obstruction to flow of blood and/or lymph
It may occur in patients with orbital tumors, cysts, endocrine exophthalmos, orbital pseudotumors, cavernous sinus thrombosis, carotico-cavernous fistula, blockage of orbital lymphatics following orbital surgery, acute congestive glaucoma, etc.
These include severe anemia and hypoproteinemia, Hyperthyroidism, congestive heart failure, nephrotic syndrome, urticaria, and angioneurotic edema.
Prior eye surgery
It can happen with any surgery around the eyes. Chemosis develops in about 5-10% of patients who’ve had lower blepharoplasty. If only the upper lids have been operated on, it’s very rare for it to occur.
If additional procedures have been performed then chemosis may be more common. Procedures can include:
- Canthopexy: tightening of the corners of the eyelids
- Canthoplasty: tightening of the lower eyelid
- Midface lift
As a result of dry eye following surgery, the conjunctiva becomes irritated and swells. This increases the exposure of the conjunctiva as it can billow out of the eyelid like jelly. Often the area swells so much that you can’t close the eye properly. This can cause excessive watering of the eyes.
Surgical procedures can disrupt the lymphatic drainage of the eyelids, not allowing the fluid to drain properly. If enough of the channels are blocked following surgery, the fluid will drain very slowly and the chemosis will persist.
Constant rubbing of the eyes
Rubbing of the eyes is one of the most common causes of conjunctival chemosis. Constant scratching or rubbing of the eyelids can cause irritation of the eyes, in some cases resulting in chemosis. If you have itchy eyes for long times, it’s important that you find out the root cause of the itchiness before dealing with the chemosis.
Signs and Symptoms of chemosis of the conjunctiva
Localized or diffused swelling of the conjunctiva being the major sign of conjunctival chemosis, following signs and symptoms are common in acute and chronic chemosis of conjunctiva.
- Less to severe injections of the conjunctiva
- Incomplete eyelids closure
- Adjacent corneal changes such as superficial punctate keratitis (SPKs), exposure keratitis, or Dellen formation
Some patients do not have any symptoms except inflammation. But others might develop any one or combination of the following symptoms.
- Excessive tearing
- Blurry vision
- Double vision (diplopia)
- Itchiness or eye irritation such as in allergic conjunctivitis
Is conjunctival chemosis dangerous?
If chemosis is caused by simple allergens and constant rubbing, it can be treated with behavioral changes and a doctor’s prescription. But, when chemosis is accompanied by other systemic illnesses, and if it is related to prior ocular surgeries, you shouldn’t ignore even the mild conjunctival chemosis. Immediately seek medical attention, in such conditions.
Treatment for chemosis of conjunctiva
The main goal of treatment is to reduce inflammation. So, to manage swelling, accompanying discomfort and reduced vision, over-the-counter antihistamines, and cool compresses (preferably ice) placed on the closed eyes may help to alleviate the symptoms caused due to allergies. Your eye doctor might advise you to stop wearing contact lenses when your eyes are suffering from this condition.
Further treatment of chemosis may depend on the underlying cause of the chemosis.
Recommended homeopathic Remedies for Conjunctival Chemosis
In most cases, tearing mainly irritates the lower eyelid and is accompanied by a patchy redness. The recommended treatment in such cases is Euphrasia 5 CH. In addition, Euphrasia-based eye drops are also effective for the treatment of the condition.
The remedy Apis mellifica, in dilutions ranging from 5 to 9 CH, is also advised to cure chemosis. If the patient has large edema near the eyelids as well as significant tearing, the recommended treatment is Kalium iodatum. In addition, if tearing is substantial but does not cause any twitching, the patient can take Allium cepa 5 CH.
When should you consult a doctor?
Medical consultation becomes mandatory if the condition persists despite taking home treatments. The patient should also seek further medical attention if his or her eye becomes hard and sore or if his or her vision reduces significantly.
Furthermore, an affected person should consult a doctor in case of nausea, vomiting, or if redness is present around the limb. If the patient suffers from diabetes, rheumatisms, or multiple sclerosis, it is primordial to seek medical advice prior to starting a home treatment for chemosis. Similarly, self-medication is not advised in case of pregnancy.
What to expect from an eye doctor?
Your eye doctor will perform a physical examination and ask questions related to your signs and symptoms, that may include:
- When did it start?
- How long does the swelling last?
- How bad is the swelling?
- How much is the eye swollen?
- What, if anything, makes it better or worse?
- What other symptoms do you have? (For example, breathing problems, nausea, vomiting)
Your treatment depends on your response to the eye doctor’s questions. So, provide detailed information about your symptoms to help the doctor find the best treatment for your condition.
How to prevent chemosis?
Allergens are major causes of chemosis. So, trying to avoid the sources of allergens reduces the risk. Similarly, taking good care of handwashing and cleanliness prevents the spread of infectious agents, such as bacteria. You should avoid constant touching and rubbing of your eyes, especially with dirty hands.
- Comprehensive Ophthalmology 4th Edition, AK Khurana
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