A Case Of Idiopathic Conjunctival Chemosis: Successful Management With Inferior Conjunctival Cauterisation.

To report a case of idiopathic conjunctival chemosis successfully managed with inferior conjunctival cauterisation.

Description of a case diagnosed and treated at the Royal United Hospitals Bath.

A 49-year old gentleman man presented with a 6 month history of persistent right sided eye irritation and redness. Examination showed significant conjunctival chemosis in the right eye, which was mobile, diffuse and non-cystic. There was no associated conjunctival injection or inflammation. There was no proptosis, impairment of ocular motility, or cervical lymphadenopathy. No past medical history of note apart from sinusitis was mentioned.

He was initially treated with olopatadine 0.2% and dexamethasone 0.1% for possible allergic eye disease, with little effect. An orbital MRI showed right sided maxillary sinus disease, which on ENT review was not thought to be contributory to his chemosis.

4 months after first presentation the symptoms and chemosis were still persistent. An inferior conjunctival cauterisation procedure was performed along with a small conjunctival biopsy, under local anaesthetic as a day case procedure. The technique involved a similar method to that used for inferior conjunctival chalasis, using a bipolar cautery probe to induce inferior conjunctival scarring to help reduce the chemosis. Histology of the biopsy confirmed normal conjunctival tissue and no malignancy was identified. At one month follow up the patient’s symptoms had resolved with good resolution of the chemosis. He did not have any post-surgical complications and the chemosis has not recurred since.

Our case highlights a simple but effective surgical technique in the management of idiopathic conjunctival chemosis, using inferior conjunctival cauterisation. Furthermore, it considers the important investigations to perform in cases of chemosis.