Chemosis
| Chemosis | |
|---|---|
| Other names: Conjunctival edema, fluid-filled conjunctiva, swollen conjunctiva[1] | |
 | |
| Allergic conjunctivitis resulting in chemosis | |
 | |
| Specialty | Opthalmology |
| Symptoms | Swelling of the whites of the eye, increased tear production, itchiness, blurry vision[2] |
| Complications | Exposure keratitis[2] |
| Types | Focal, diffuse[3] |
| Causes | Allergic, viral, or bacterial conjunctivitis[4] |
| Differential diagnosis | Conjunctivochalasis[5] |
| Treatment | Eye lubrication, NSAIDS[2][6] |
| Prognosis | Good[7] |
| Frequency | Relatively common[3] |
Chemosis is the superficial swelling of the whites of the eye and the insides of the eyelids.[2] Symptoms may vary from none to increased tear production, itchiness, and blurry vision.[2] There is generally no pain, though irritation may be present.[1][3] A small location or the entire whites may be affected.[2] It may make it difficult to fully close the eye, which can result in exposure keratitis.[2]
It most commonly occurs due to allergic, viral, or bacterial conjunctivitis.[4][3] Other causes may include a mass behind the eye such as in thyroid eye disease, an eye injury, angioedema, or heart failure.[2][8][9] The underlying mechanisms may involve increased permeability of capillaries, low albumin, or high venous pressure.[9]
Management involves addressing the underlying cause.[2] Eye lubrication and NSAIDS may also help.[2][6] Generally it resolves with time and outcomes are good.[6][7] An exception is if bleeding is present within the chemosis in the setting of an injury, which could indicate globe rupture.[7] It is relatively common.[3] The term is from the Greek cheme, meaning cockleshell and -osis, meaning condition.[10]
Signs and symptoms
Symptoms may vary from none to increased tear production, itchiness, and blurry vision.[2] A small location or entire whites of the eye may be affected.[2] It may make it difficult to fully close the eye, which can result in exposure keratitis.[2]
-
An eye with a mild swollen region of the conjunctiva (front view). -
Moderate chemosis of the lower conjunctiva due to thyroid eye disease. -
Severe chemosis of the lower conjunctiva due to thyroid eye disease. -
Severe chemosis of the lower conjunctiva due to thyroid eye disease.
Causes
It is usually caused by allergies or viral infections, often worsened by excessive eye rubbing. Chemosis is also included in the Chandler Classification system of orbital infections.
Other causes of chemosis include:
- Superior vena cava obstruction, accompanied by facial oedema
- Hyperthyroidism, associated with exophthalmos, periorbital puffiness, lid retraction, and lid lag
- Cavernous sinus thrombosis, associated with infection of the paranasal sinuses, proptosis, periorbital oedema, retinal haemorrhages, papilledema, extraocular movement abnormalities, and trigeminal nerve sensory loss
- Carotid-cavernous fistula - classic triad of chemosis, pulsatile proptosis, and ocular bruit
- Cluster headache
- Trichinellosis
- Systemic lupus erythematosus (SLE)
- Angioedema
- Acute glaucoma
- Panophthalmitis
- Orbital cellulitis
- Gonorrheal conjunctivitis
- Dacryocystitis
- Spitting cobra venom to the eye
- High concentrations of phenacyl chloride in chemical mace spray
- Urticaria
- Trauma
- HSV Keratitis
- Post surgical
- Mucor
- Rhabdomyosarcoma of the orbit[11]
Diagnosis
Diagnosis is usually by examination of the affected area.
Treatment
Treatment depends on the cause. If chemosis has occurred due to excessive rubbing of the eye, the first aid to be given is a cold water wash for eyes.
References
- ↑ 1.0 1.1 "Swollen Conjunctiva". American Academy of Ophthalmology. 19 June 2012. Archived from the original on 2 October 2024. Retrieved 30 September 2024.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 "Chemosis". Vagelos College of Physicians and Surgeons. 25 April 2022. Archived from the original on 11 July 2024. Retrieved 30 September 2024.
- ↑ 3.0 3.1 3.2 3.3 3.4 Hartstein, Morris E.; Burkat, Cat Nguyen; Ramesh, Sathyadeepak; Holds, John B. (10 October 2020). Avoiding and Managing Complications in Cosmetic Oculofacial Surgery. Springer Nature. p. 54. ISBN 978-3-030-51152-4. Retrieved 8 October 2024.
- ↑ 4.0 4.1 "Conjunctivitis - EyeWiki". eyewiki.org. Archived from the original on 2 October 2024. Retrieved 30 September 2024.
- ↑ Wiersinga, Wilmar M.; Kahaly, George (2007). Graves' Orbitopathy: A Multidisciplinary Approach. Karger Medical and Scientific Publishers. p. 9. ISBN 978-3-8055-8342-8. Retrieved 8 October 2024.
- ↑ 6.0 6.1 6.2 Kontoes, Paraskevas (21 April 2017). State of the art in Blepharoplasty: From Surgery to the Avoidance of Complications. Springer. p. 90. ISBN 978-3-319-52642-3. Retrieved 8 October 2024.
- ↑ 7.0 7.1 7.2 Brightbill, Frederick S. (1 January 2009). Corneal Surgery: Theory, Technique and Tissue. Elsevier Health Sciences. p. 141. ISBN 978-0-323-04835-4. Retrieved 8 October 2024.
- ↑ Leahey, Alan B. (1 May 1992). "Chemosis as a Presenting Sign of Systemic Lupus Erythematosus". Archives of Ophthalmology. 110 (5): 609. doi:10.1001/archopht.1992.01080170031011. PMID 1580831.
- ↑ 9.0 9.1 Orient, Jane M.; Sapira, Joseph D. (2010). Sapira's art & science of bedside diagnosis: "online access to fully searchable text and question bank." (4. ed.). Philadelphia, Pa.: Wolters Kluwer Health, Lippincott Williams & Wilkins. p. 178. ISBN 978-1-60547-411-3. Retrieved 8 October 2024.
- ↑ "chemosis - Definition | OpenMD.com". openmd.com. Retrieved 2023-02-19.
- ↑ "Narang, G.S., Pahwa, J.S. Pediatric Oncall Child Health Care. Fungating orbital mass Question. 8 Feb 2011". Archived from the original on 2 October 2024. Retrieved 17 August 2023.
External links
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