The comprehensive management of chemosis following cosmetic lower blepharoplasty.

BACKGROUND: Chemosis can cause persistent discomfort and aggravation in the postoperative period following surgery of the eyelids. This article focuses on chemosis associated with cosmetic lower blepharoplasty. The cause is multifactorial and includes exposure, periorbital edema, and postoperative lymphatic dysfunction.

METHODS: A chart review of 312 primary bilateral lower transcutaneous blepharoplasties was performed. Data were collected to identify the incidence of chemosis, define associated etiologic factors, develop a chemosis classification system, and outline a successful treatment algorithm.

RESULTS: The incidence of chemosis was 11.5 percent in this population of lower lid blepharoplasty patients. Chemosis presented intraoperatively or up to 1 week postoperatively. The median duration was 4 weeks, with a range from 1 to 12 weeks. Associated etiologic factors included conjunctival exposure, periorbital and facial edema, and lymphatic dysfunction. The four general patterns of presentation were classified as type 1, acute mild chemosis with complete lid closure; type 2, acute severe chemosis that prohibits complete lid closure (chemosis-induced lagophthalmos); type 3, subchronic chemosis that persists longer than 3 weeks; and type 4, chemosis associated with lower lid malposition. Successful treatment existed along a continuum from liberal lubrication to ophthalmic steroid preparations and ocular decongestants to eye-patching to minor surgical procedures such as drainage conjunctivotomy and temporary tarsorrhaphy. In all cases, chemosis ultimately resolved.

CONCLUSIONS: Chemosis is a common complication of lower blepharoplasty. Pharmacologic, mechanical, and surgical therapies may be used alone or in combination for the successful management of chemosis. Prevention by minimization of triggering factors intraoperatively and immediately postoperatively is important.