ESCRS - P216 - AQUEOUS CHEMOSIS IN NEPHROTIC SYNDROME

AQUEOUS CHEMOSIS IN NEPHROTIC SYNDROME

Published 2022 - 26th ESCRS Winter Meeting

Reference: P216 | Type: Abstracts | DOI: 10.82333/evh3-qp85

Authors: Neama Bouhazzama* 1 , Hamza Alaoui 1 , Zineb Hammoumi 1 , Loubna Maaloum 1 , Bouchra Allali 1 , Asmaa Kettani 1

1Ophtalmology,Hopital 20 Aout 1953, CHU Ibn Rochd,El Jadida,Morocco

Purpose

Aqueous chemosis = white chemosis is defined as edema of the bulbar conjunctiva.

Main etiology: allergic reaction.

Rare and reversible complication of nephrotic syndrome, it occurs mainly in children. We report a case of aqueous chemosis in the context of a nephrotic syndrome seen in the ophthalmological emergency department of the August 20th 1953 Hospital.

Setting

ophthalmology department; August 20th,1953 hospital Ibn Rochd University Hospital Center Faculty of Medicine and Pharmacy Casablanca Hassan II University (Morocco)

Methods

 Our patient is a 42-year-old man  , followed in nephrology for extra capillary glomerulonephritis.
 The ophthalmologic examination found:
 Visual acuity maintained at 10/10 in both eyes,
 Ocular motility preserved, Photomotor reflexes present and symmetrical
 slit lamp: Bilateral, non-inflammatory aqueous chemosis, more pronounced in the left eye (temporally),
 Anterior segment: calm,
 Fundus: papilla with clear contours and normal coloring, normal cup/disc  and macula in both eyes.
 In addition, the general clinical examination found:
 Blood pressure rise (160/100 mmHg)
 Pleural effusion syndrom
 Edema of the lower limbs 
 Biology report:
 Hypoprotidemia: 35g / L
 Deep hypoalbuminemia: 22g / L
 Proteinuria: 15g / 24h
 Renal function: preserved (Cl = 50)
 Chest x-ray: bilateral pleural effusion
 Abdominal ultrasound: slight intraperitoneal fluid effusion, with slight nephromegaly

Results

The diagnosis of nephrotic syndrome in the setting of glomerulonephritis led to the administration:  diuretic treatment,  anti-thrombotic, and corticosteroid therapy.
 No local ophthalmologic treatment was prescribed.
 Good clinical-biological evolution and in particular a regression of bilateral chemosis.
 Aqueous chemosis is a rare and unusual complication of nephrotic syndrome in adults. 
 Two cases of bilateral aqueous chemosis in nephrotic syndrome have been reported in the literature in a 15-year-old child and in a 3-year-old goat. 
 Chemosis, or conjunctival edema, can be inflammatory or non-inflammatory.
 Non-inflammatory (watery) chemosis is most often secondary to an allergic reaction.

Conclusion

Aqueous chemosis in nephrotic  syndrom is a rare but benign complication.
 It is believed to be secondary to fluid retention due to hypoprotidemia.
 No local treatment is indicated, and the regression of chemosis would be concomitant with the disappearance of the clinico-biological nephrotic syndrome.