Caption: FIGURE 3: The tear ferning test (TFT) score shows direct correlation with mucous secretion severity (p = 0.004, R = 0.373) (a) and conjunctival chemosis
(p = 0.031, R = 0.278) (b), indicating altered quality of the lacrimal mucous component.
In the current case, visual acuity and chemosis
improved, but other items such as soft tissue involvement and extraocular muscle involvement still had elevated scores [Table 1].
The patient's symptoms improved rapidly after initiation of anti-coagulation, including resolution of chemosis
Table 1: Mean scores of ocular signs and symptoms at baseline, Visits 1 and 2 Variable Olopatadine 0.2% OD Baseline Visit 1 Visit 2 Redness 2.57 0.84 0.51 Chemosis
0.33 0.06 0.04 Lid edema 0.29 0.04 0.00 Itching 2.71 0.71 0.27 Discomfort 1.98 0.14 0.06 Foreingn body sensation 2.31 0.08 0.02 Stinging 2.16 0.02 0.00 Photophobia 0.65 0.02 0.00
Neurological examination showed chemosis
, limited eye movements in all directions, and minimal exophthalmos in the left eye on the sixth day, as non-existing symptoms on admission (Figure 1(a)).
Regarding clinical manifestations, signs of chemosis
, blepharospasm, ocular discharge, hyperemia, and corneal opacity/edema were observed.
 Clinical reports have shown that contact with PPD leads to irritation of skin, dermatitis, arthritis, asthma, conjunctivitis, chemosis
, exophthalmos, lacrimation, and even permanent blindness.
The principal features are periorbital pain and edema, diplopia, chemosis
, ptosis, and gaze paresis (4,5).
Ocular complications include uveitis, keratitis, conjunctivitis, conjunctival edema (chemosis
), ocular muscle palsies, scleritis, retinal vascular occlusion and ulceration, scarring and even necrosis of the lids.1
Minor complications after blepharoplasty: dry eyes, chemosis
, granulomas, ptosis, and scleral show.
Blood stained discharge was coming from both the eyes due to chemosis
and conjunctival lacerations.
Clinical signs 1 Conjunctival and relapsing lesions in both eyes 2 Mild scleritis, proliferative eye lesions 3 Episcleral swelling and vascular congestion, squinting, scleral indentation in the temporal fundus 4 Inflammatory conjunctival follicles, mild epiphora, mild diffuse conjunctival hyperemia, episcleral 5 Moderate blepharospasm and conjunctival hyperemia 6 Moderate chemosis
, episcleral flocculent mass 7 Chronic waxing/waning episcleral mass 8 Chronic conjunctivitis, superficial keratitis, episcleral mass, chemosis