EpistemisConjunctival chemosis
Specialty: Ophthalmology.
Why it occurs
- Acute localized allergic hypersensitivity reaction (e.g., due to contact with pollen, mites, or insect bites)
- Orbital cellulitis or active thyroid inflammatory orbitopathy
- Orbital venous obstruction due to cavernous sinus thrombosis or carotid-cavernous fistula
- Chemical burn (especially from strong alkaline or acidic agents) or conjunctival mechanical trauma
- Early postoperative period of major ophthalmic surgery (strabismus, retinal surgery or glaucoma)
Initial workup
Slit lamp biomicroscopy evaluating the tension and hydration of the conjunctival stroma and looking for the presence of concomitant conjunctival ulcerations; Measurement of intraocular pressure using rebound or pneumatic tonometry; Brain and orbital magnetic resonance imaging with sequences for venous sinuses in suspected retrobulbar pathology of vascular or obstructive origin.
red flags
Massive chemosis of rapid onset, unilateral, protruding through the eyelids without allowing eye closure, accompanied by proptosis, severe progressive headache, ophthalmoplegia and high fever, indicative of cavernous sinus thrombosis, requiring immediate hospitalization due to the risk of sepsis and cerebral infarction.
Standard management
- Dexamethasone — 0.1% eye drops, 1 drop every 4-6 hours in severe acute non-infectious ocular inflammatory processes, under strict control of intraocular pressure due to risk of cortisonic glaucoma
- Olopatadine — 0.2% eye drops, 1 drop per day in case of chemosis of acute allergic origin to block histaminergic receptors
- Naphazoline (0.1% eye drops, 1 drop every 8 hours for a maximum of 3-5 days to induce temporary local vasoconstriction, used under strict caution not to make its use chronic).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 5
- Treatment options
- 3