Chemosis 3 weeks after lower eyelid surgery. How can I speed up my recovery? (Photo)

You are still swollen after surgery.  The conjunctiva (white of the eye) also swells and that is chemosis.  Chemosis can persist from transient damage to the conjunctival lymphatics.  However, the most common issue for persistent chemosis is drying and exposure.  This is particularly acute for some for 6 to 8 weeks after surgery due to motor weakness of the eyelids.  The very best and simplest approach to chemosis in this situation is lubrication which involves frequent lubrication.  Artificial tears are every 30 minutes is less likely to interfere with vision.  When the conjuctiva is so swollen that it is exposed even when the eyes are closed, this approach will not work and bland ophthalmic ointment is best to provide lubrication and moisture to the cornea and conjunctiva.  At bedtime the ointment is best.  Medicated ointments such as tobradex are very irritating and are not the best choice under the circumstance.  In particular, the tobramycin in the ointment is toxic to the conjunctiva and cornea.  We accept this irritation when there is an active infection but here there is no active infection.  The irritation stirred up will not help the conjunctiva get better.  Also you are getting a lot of steroid between the oral steroids, and dexamethasone in the tobradex, and the steroid in the Lotemax.  Patching as suggested can be useful for settling the chemosis in certain circumstances.  I encourage you to see a cornea specialist or an oculoplastic surgeon specifically for chemosis management.  A general plastic surgeon and a general ophthalmologist may not provide the right expertise in this circumstance.  Certainly a second opinion under the circumstance is reasonable.

Chemosis is hard to treat as you now know.  We think it occurs due to a disruption of the normal lymphatic drainage.  Anti-inflammatories as you have tried may help.  Lots of lubrication with artificial tears during the day and ointment at bedtime will also help.  You may want to try patching the eye when asleep.  I have patients massage the lid up over the chemosis to try and stimulate the lymphatic drainage.  If very stubborn cases a small conjunctival surgery may be needed.  It will eventually clear.     

If chemosis is chronic, then other treatments such as patching the eye or possibly small conjunctiva surgery may be necessary. See link on my website for more information.

You most likely have chemises which can occur with eyelid  surgery.   It may last several weeks especially if exposure and dryness of the eye are major  contributors.  Ointment can help along with patching of the eye.  In severe cases a tarsorhaphy may be performed which is suturing the upper and lowers lid together slightly to protect the eye.  Make sure to follow up with your  surgeon and possibly get and opthalmologic exam to make  sure there is no underlying trauma.