Eyelid Surgery: What is Chemosis and how to treat it

1. What is chemosis?

It’s the jelly like swelling (edema) of the conjunctiva that lines the inner part of the eyelid.

Most of the time, chemosis appears on a small area on the outer corner of the sclera (the white part of the eye).

As a result of dry eye following surgery, the conjunctiva becomes irritated and swells. This increases 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 tearing, however the real underlying problem is dryness and irritation of the eyes.

When can chemosis occur?

It can happen with any surgery around 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.

Chemosis develops most commonly 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

Another possible cause of chemosis may be an allergy to the eye drops or lubricant used after surgery.

Pre-existing problems with dry eye can also contribute to the problem.

How long does chemosis last?

Mild chemosis after blepharoplasty will settle down, but sometimes it can take several months.

How to treat chemosis

The simplest approach to resolving chemosis due to dry eye is aggressive dry eye management.

Artificial tears should be used at least every hour throughout the day.

It should be ensured that the eyes are closing fully at night and the affected eye should be covered with a bland

ophthalmic ointment.

If the eye is not fully closing, it should be covered with an eye patch for compression or with plastic wrap to keep it moist.

Additional measures may be needed such as steroid drops or oral steroids.

Antibiotics are useful if there has been any damage to the surface of the eye, in order to prevent infection from occurring.

In particularly difficult cases, sometimes the eyelid (in order to heal) needs to be temporarily closed using a tarsorrhaphy stitch, alternatively surgical revision may be required.

Your plastic surgeon should be your first contact. Let your them decide if a consultation with an ophthalmologist may be warranted to rule out other problems.

If you have any unanswered questions on chemosis or eyelid surgery, but are not yet ready to commit to a one on one consultation, I invite you to attend a free information evening with me. Click on the button below to learn more and reserve your seat.

Dr Naveen Somia MBBS, PhD, FRACS+61 2 9387 2110

www.naveensomia.com.au

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