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Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead: A Case Report.

Abstract

Although cosmetic facial soft tissue fillers are generally safe and effective, improper injections can lead to devastating and irreversible consequences. We represent the first known case of posterior ciliary artery occlusion caused by hyaluronic acid. A 41-year-old female presented with right visual loss 7 hours after receiving cosmetic hyaluronic acid injections into her forehead. Examination revealed no light perception in the right eye and multiple dark ischemic area of injection over the forehead and nose. The right fundus revealed a pink retina with optic nerve edema. Fluorescein angiogram showed several filling defects in the choroidal circulation and late hyperfluorescence in the choroid. A right posterior ciliary artery occlusion and embolic occlusion of facial artery braches was diagnosed. With hyaluronidase injection, hyperbaric oxygen therapy, oral aspirin, oral acetazolamide and dexamethasone venotransfuse treatment, the patient's forehead and nasal skin improved and vision recovered to hand movements. With proper technique, vascular occlusion is rare following facial filler injection. Vision consequences can be severe if filler emboli enter the ocular circulation. Physicians should be aware of this potential side effect, recognize its presentation, and be knowledgeable of effective management.

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  • Authors+Show Affiliations

    ,

    From the Department of Ophthalmology (XZH, JYH, PSW, WL), The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China; Department of Anatomy (SBY), Dalian Medical University, Dalian, China; Division of Ophthalmic Plastic and Reconstructive Surgery (DOK), UC San Diego Department of Ophthalmology, Shiley Eye Institute, CA.

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    Source

    Medicine 95:11 2016 Mar pg e3124

    MeSH

    Adult
    Blindness
    Ciliary Arteries
    Cosmetic Techniques
    Dermal Fillers
    Embolism
    Female
    Forehead
    Humans
    Hyaluronic Acid
    Injections, Subcutaneous

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    26986163

    Citation

    Hu, Xiu Zhuo, et al. "Posterior Ciliary Artery Occlusion Caused By Hyaluronic Acid Injections Into the Forehead: a Case Report." Medicine, vol. 95, no. 11, 2016, pp. e3124.
    Hu XZ, Hu JY, Wu PS, et al. Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead: A Case Report. Medicine (Baltimore). 2016;95(11):e3124.
    Hu, X. Z., Hu, J. Y., Wu, P. S., Yu, S. B., Kikkawa, D. O., & Lu, W. (2016). Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead: A Case Report. Medicine, 95(11), pp. e3124. doi:10.1097/MD.0000000000003124.
    Hu XZ, et al. Posterior Ciliary Artery Occlusion Caused By Hyaluronic Acid Injections Into the Forehead: a Case Report. Medicine (Baltimore). 2016;95(11):e3124. PubMed PMID: 26986163.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Posterior Ciliary Artery Occlusion Caused by Hyaluronic Acid Injections Into the Forehead: A Case Report. AU - Hu,Xiu Zhuo, AU - Hu,Jun Yan, AU - Wu,Peng Sen, AU - Yu,Sheng Bo, AU - Kikkawa,Don O, AU - Lu,Wei, PY - 2016/3/18/entrez PY - 2016/3/18/pubmed PY - 2016/8/3/medline SP - e3124 EP - e3124 JF - Medicine JO - Medicine (Baltimore) VL - 95 IS - 11 N2 - Although cosmetic facial soft tissue fillers are generally safe and effective, improper injections can lead to devastating and irreversible consequences. We represent the first known case of posterior ciliary artery occlusion caused by hyaluronic acid. A 41-year-old female presented with right visual loss 7 hours after receiving cosmetic hyaluronic acid injections into her forehead. Examination revealed no light perception in the right eye and multiple dark ischemic area of injection over the forehead and nose. The right fundus revealed a pink retina with optic nerve edema. Fluorescein angiogram showed several filling defects in the choroidal circulation and late hyperfluorescence in the choroid. A right posterior ciliary artery occlusion and embolic occlusion of facial artery braches was diagnosed. With hyaluronidase injection, hyperbaric oxygen therapy, oral aspirin, oral acetazolamide and dexamethasone venotransfuse treatment, the patient's forehead and nasal skin improved and vision recovered to hand movements. With proper technique, vascular occlusion is rare following facial filler injection. Vision consequences can be severe if filler emboli enter the ocular circulation. Physicians should be aware of this potential side effect, recognize its presentation, and be knowledgeable of effective management. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/26986163/Posterior_Ciliary_Artery_Occlusion_Caused_by_Hyaluronic_Acid_Injections_Into_the_Forehead:_A_Case_Report_ L2 - http://Insights.ovid.com/pubmed?pmid=26986163 DB - PRIME DP - Unbound Medicine ER -