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Chemosis After Blepharoplasty

I had upper and lower blepharoplasty, and I still have severe chemosis on one eye after 9 weeks. I am using tear drops and a lubricant, and I'm also taking antibiotics. Will this heal, and how long will it take? I'm very depressed.

Doctor Answers (18)

Chemosis after Blepharoplasty

+3

Although it can happen with any surgery around the eyes (and to any plastic surgeon for this matter), chemosis develops most commonly if lower blepharoplasty has been part of the procedure. If only the upper lids have been operated, it is very rare. If additional procedures have been performed such as canthopexy, canthoplasty or midface lift, chemosis may be more common.

Although after 9 weeks, understandably, most patients and surgeons lose their patience, chemosis will resolve. Many physicians may add steroids to the "mix" of treatments, I tend to believe that still less is more as there is no good scientific data that it actually will help the underlying condition of lymphatic drainage compromize. And any medication has their risk, too.

You are doing the right things! Stay in touch with your surgeon and we all hope for a quick resolution.


Worcester Facial Plastic Surgeon
4.5 out of 5 stars 24 reviews

An unfortunate complication

+3

Chemosis after blepharoplasty is one of the complications we all look to prevent. This can occur because of a negative vector or is more common in women in their 40's and 50's because dry eyes tend to occur more in these ages due to hormone changes.

You're doing everything right. And usually chemosis will resolve without surgery. As the other physicians have stated steroids may help. You might also consider seeing an Ophthalmologist for a second opinion or evaluation of the duct.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 16 reviews

Chemosis will resolve

+3

Ann,

Chemosis can be a very frustrating complication from blepharoplasty.  The treatment includes natural tear drops, steroid eye drops and sometimes even a temporary stitching together of your eyelids (tarsorrhaphy).  See your surgeon for treatment options and good luck.

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

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You need aggressive dry eye treatment

+3

Dear Annouscka,

Chemosis is swelling of the conjunctiva following eyelid surgery. The conunctiva is the white covering that surrounds the eye. Just like the eyelids swell after eyelid tissue, the conjunctiva can also swell.

Chemosis is common enough although an incidence of 10% is overstating how often it should occur following cosmetic eyelid surgery. Certain surgical maneuvers are much more likely to cause chemosis, which is thought to be related to disruption of the eyelid lymphatics. In particular, certain midface maneuvers that seek to tighten the lower eyelid including the so called coronocanthoplasty are more likely to produce this condition.

So, canthopexy, a tightening procedure of the lower eyelid, can be associated with chemosis. Making an upper and lower eyelid incision too close to each other in the outer corner of the eyelid tissues is also associated with a higher incidence of chemosis. Preexisting dry eye also contributes to the problem.

Chemosis is usually transient and self limited. However, there are certain conditions where the chemosis can persist. In particular, if the eyes do not closed well after eyelid surgery, there can be continual drying and irritation of the chemosis. This prevents the chemosis form settling down. When chemosis is severe enough, the tissues will actually poke out from behind the eyelids and this makes the drying problem worse.

The simplest approach to resolving chemosis is aggressive dry eye management. Artificial tears should be used at least every hour during the day. At night the eye should be covered with bland ophthalmic ointment. If in fact the eyelids are not fully closing, plastic wrap should be used to cover the eye at night. Do not use a cotton eye pad as this will only dry out the eye. Taping can also help in more extreme cases. This could take several weeks to resolve once you turn the corner on the drying that is permitting this condition to persist.

Finally, there are truly persistent cases of chemosis. These are quite rare. There are circumstances where conjunctival surgery is needed to make the situation better. Again, these situations are quite rare. I think that you should see an ophthalmologist or an eye plastic consultant to help manage this problem.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

It will go away.

+3

Hi! Chemosis happens about 10% of the time after blepharoplasty. I sometimes use a temporary tarsorrhaphy (technical detail) to minimize this, but it can still happen.

It looks terrible and it is very annoying. The good news is that it does not do any harm and that it goes away. By all means see an ophthalmologist for further reassurance and to make sure there is nothing unusual going on.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

9 weeks is too long for chemosis after blepharoplasty

+3

9 weeks is a long time to have Chemosis after blepharoplasty.

Something must be continuing to inflame and irritate your eyes.

Most likely your eye continues to be dry-perhaps the eyelids are too open from drooping of the lower eyelid or incomplete closure of the upper lid.

Alternatively you may be ALLERGIC to the eye drops or lubricant. I have seen that happen before and it will cause chemosis.

Consult your doctor or if not available, see an ophthamologist.

If the eyelids are normal and the eye not too widely opened (lagophthalmos or ectropion), then I would stop the medications you are using on your eyes and try a steroid anti inflammatory such as Tobradex or FML ophthalmic drops.

These are prescription items so you must see a doctor

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 28 reviews

Don't be depressed as with time it should all resolve

+2

Chemosis takes a long time to resolve and full resolution takes 6weeks to 3 months. Although I have only experienced that once in my carrier, it can occur and it takes weeks to months to gradually resove. I would not recommed using steriod eye drops for more than a few weeks as it increases the risks of cataracts.

Waiting and cold compresses may be the best remedy

Amir Moradi, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

Hard to tell

+2

It is impossible to tell exactly. You may want to ask your doctor about steroid eye drops, or perhaps a small procedure to correct it. Sometimes, cool compresses and gentle massage to the closed eyelid may also help, but again, check with your doctor.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

Would use steroid drops by this time

+2

Chemosis, or inflammation of the conjunctiva, happens about 20% of the time, even to the best of surgeons. It is usually treated initially by the measures you have mentioned. When it persists, as yours has, use of steroid drops is the next treatment, unless you have some contraindication. If so, there are non-steroidal antiinflammatory drops that can be used.

Occasionally, resection of persistently edematous (swollen) conjunctiva is necessary, but exceptionally rare. Although it is way too early to consider revision of the blepharoplasty, occasionally swelling or other factors (such as, in my own case, wearing a surgical mask that pulled the eyelid down for a period of time) can contribute to the continued irritation. Elimination of the instigating problem and occasionally massage of persistent edema can also lead to improvement.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Persistant chemosis is a tough problem

+2

Chemosis can be a real problem and in a major US publication it has an incidence of 25%. Many things can be done to help prevent this problem but it still can occur. It seems that you have been instructed to do some of the usual things for chemosis such as eye drops, and lubiricants. Even though there can be tearing that goes down your cheeks the real underlying problem can actually be dryness of the eyes. Make sure that you eyes are closing fully at night and use the ointment in your eyes at night. You should consult with your surgeon to determine if additional measures may be needed such as steroid drops, oral steroids, patching or even a revision of the eyelids if there is exposure. Sometimes it the chemosis conditions last for over 2 months there may actually be a lymphatic obstruction, ie, the fluid is not draining properly. There are 3 lymph channels that drain the lower eyelid, if enough of the channels are blocked then the eye will not drain properly and the chemosis will persist. The good news is that this usually resolved by 3 months. Follow the advice of your surgeon and the condition will improve.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.