20.1 Introduction

Chemosis or edema of the conjunctiva is one of the more common and relatively benign complications following blepharoplasty. It is most often associated with lower lid procedures, especially those involving the lateral canthal area.

The fluid collects in the natural plane between Tenon’s capsule and the conjunctiva (Fig. 20-1).

The typical appearance seen in Fig. 20-2, where the collection is sharply demarcated at the cornea, results from the firm adherence of Tenon’s capsule and conjunctiva to the underlying sclera at the corneoscleral limbus.

Chemosis results from the reaction of the conjunctiva to inflammation following surgery, allergies, trauma, infection, and even Graves’ disease. Chemosis following blepharoplasty is most likely the result of inflammation. Its association with canthal procedures also raises the possibility of lymphatic disruption as a contributing factor. Predisposing conditions for chemosis include patients with compromised eyelid closure, lid laxity, ocular surface pathology, and conjunctivochalasis.

Once the initial inflammation has led to accumulation of chemosis fluid, a cycle may begin, prolonging the process (Fig. 20-3). As the conjunctiva becomes desiccated, more inflammation ensues, displacing the eyelid from the cornea and limiting lid closure. This leads to further corneal drying and the cycle continues till interrupted by treatment. Lubrication and patching will temporarily interrupt the cycle till permanent resolution is achieved.