Chemosis during cataract surgery is the ballooning of the conjunctiva caused by balanced salt solution (BSS) leaking under the tissue. This usually happens if the clear corneal incision is placed too posteriorly or if the phaco probe inadvertently nicks the conjunctiva. The resulting fluid buildup can pool over the cornea, distorting the surgeon’s view and making the procedure more difficult. To manage intraoperative chemosis, surgeons typically use a sharp instrument, like a paracentesis blade or Westcott scissors, to make small, radial fenestrations (cuts) in the conjunctiva. These openings allow the trapped fluid to egress. Alternatively, gentle pressure with a surgical sponge or cotton-tipped applicator can “milk” the fluid out through the incisions, flattening the tissue and restoring a clear, stable view for the remainder of the surgery. Now the subconjunctival hemorrhage is because toothed forceps were using to fixate the globe for the incision.
