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Conjunctival chemosis during cataract surgery
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 Chemosis during surgery may stretch Tenon's fascia and predispose to postoperative development of conjunctival chalasis symptoms. |
Conjunctival chemosis sometimes occurs during cataract surgery when a clear corneal incision (whether primary incision or paracentesis) is placed posteriorly enough that leaking fluid exiting the eye can be partially diverted under the conjunctiva. When the conjunctiva balloons forward, balanced salt solution can pool on the corneal surface, altering the optics of the view of the anterior chamber and making the procedure difficult.
When it occurs, one maneuver that can reduce this chemosis almost instantly is to create a small incision (with scissors) in the most dependent part of the temporal conjunctiva. By cutting deeply into Tenon's fascia, fluid can be released from the subconjunctival space, reducing the chemosis and improving the view of the anterior chamber.
Improving the surgical view is not the only reason surgeons should minimize this accumulation of subconjunctival fluid accumulation. Among older patients undergoing cataract surgery, conjunctival swelling loosens the Tenon's fascia connecting the conjunctiva and sclera, and this can lead to conjunctival chalasis.
Conjunctival chalasis is a common and frustrating ocular surface condition that causes ocular surface pain after cataract and other surgeries. It has symptoms that are similar to dry eye and is frequently misdiagnosed as this condition or as post-surgical incisional pain. Unlike incisional pain, which requires counseling and patience, or dry eye, with all its treatments, conjunctival chalasis often requires a surgical approach. More detail on this condition and its surgical treatment can be found here.
I would welcome comments and useful tips from surgeons on avoiding ocular surface discomfort following cataract and other surgical procedures.