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BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: A CASE OF OPHTHALMIC ARTERIAL OCCLUSION.

Abstract

PURPOSE

Cosmetic vein sclerotherapy is increasingly used to treat varicose veins because of its effectiveness and adherence with British Pharmacopoeia specifications. We present the first documented case of ophthalmic artery occlusion resulting in panocular ischemia secondary to intravascular injection of sodium tetradecyl sulfate sclerosant in a young healthy women seeking treatment for prominent facial veins in her forehead.

METHODS

The patient presented with unilateral sudden loss of vision. Funduscopy demonstrated a pale retina, cherry-red spot, and sclerosant visualized directly at the macula. She underwent emergency treatment for central retinal artery occlusion followed by fundal photographs, fluorescein angiography, and optical coherence tomography.

RESULTS

Despite intervention, the vision remained no perception to light. Magnetic resonance imaging, echocardiography, and Doppler ultrasound were unremarkable. The patient later developed neovascular sequelae requiring laser pan-retinal photocoagulation.

CONCLUSION

Widely regarded as safe, and approved by the U.S. Food and Drug Administration, the only published ocular side effects of foam sclerotherapy are transient visual disturbances or temporary scotomas. This case demonstrates irreversible loss of vision as a previously unreported complication. While undoubtedly rare, we believe physicians and surgeons using sclerosant in the orbital adnexa, face, nose, and sinuses should be aware of this sight-threatening complication of injection and counsel potential patients accordingly.

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  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, United Kingdom.

    , , ,

    Source

    MeSH

    Adult
    Arterial Occlusive Diseases
    Blindness
    Cosmetic Techniques
    Female
    Forehead
    Humans
    Ophthalmic Artery
    Retinal Artery Occlusion
    Sclerosing Solutions
    Sclerotherapy
    Sodium Tetradecyl Sulfate

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    28267111

    Citation

    Arunakirinathan, Meena, et al. "BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: a CASE of OPHTHALMIC ARTERIAL OCCLUSION." Retinal Cases & Brief Reports, vol. 13, no. 2, 2019, pp. 185-188.
    Arunakirinathan M, Walker RJE, Hassan N, et al. BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: A CASE OF OPHTHALMIC ARTERIAL OCCLUSION. Retin Cases Brief Rep. 2019;13(2):185-188.
    Arunakirinathan, M., Walker, R. J. E., Hassan, N., Ameen, S., & Younis, S. (2019). BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: A CASE OF OPHTHALMIC ARTERIAL OCCLUSION. Retinal Cases & Brief Reports, 13(2), pp. 185-188. doi:10.1097/ICB.0000000000000559.
    Arunakirinathan M, et al. BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: a CASE of OPHTHALMIC ARTERIAL OCCLUSION. Retin Cases Brief Rep. 2019;13(2):185-188. PubMed PMID: 28267111.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - BLIND-SIDED BY COSMETIC VEIN SCLEROTHERAPY: A CASE OF OPHTHALMIC ARTERIAL OCCLUSION. AU - Arunakirinathan,Meena, AU - Walker,Robbie J E, AU - Hassan,Noor, AU - Ameen,Sally, AU - Younis,Saad, PY - 2017/3/8/pubmed PY - 2019/5/7/medline PY - 2017/3/8/entrez SP - 185 EP - 188 JF - Retinal cases & brief reports JO - Retin Cases Brief Rep VL - 13 IS - 2 N2 - PURPOSE: Cosmetic vein sclerotherapy is increasingly used to treat varicose veins because of its effectiveness and adherence with British Pharmacopoeia specifications. We present the first documented case of ophthalmic artery occlusion resulting in panocular ischemia secondary to intravascular injection of sodium tetradecyl sulfate sclerosant in a young healthy women seeking treatment for prominent facial veins in her forehead. METHODS: The patient presented with unilateral sudden loss of vision. Funduscopy demonstrated a pale retina, cherry-red spot, and sclerosant visualized directly at the macula. She underwent emergency treatment for central retinal artery occlusion followed by fundal photographs, fluorescein angiography, and optical coherence tomography. RESULTS: Despite intervention, the vision remained no perception to light. Magnetic resonance imaging, echocardiography, and Doppler ultrasound were unremarkable. The patient later developed neovascular sequelae requiring laser pan-retinal photocoagulation. CONCLUSION: Widely regarded as safe, and approved by the U.S. Food and Drug Administration, the only published ocular side effects of foam sclerotherapy are transient visual disturbances or temporary scotomas. This case demonstrates irreversible loss of vision as a previously unreported complication. While undoubtedly rare, we believe physicians and surgeons using sclerosant in the orbital adnexa, face, nose, and sinuses should be aware of this sight-threatening complication of injection and counsel potential patients accordingly. SN - 1937-1578 UR - https://www.unboundmedicine.com/medline/citation/28267111/BLIND_SIDED_BY_COSMETIC_VEIN_SCLEROTHERAPY:_A_CASE_OF_OPHTHALMIC_ARTERIAL_OCCLUSION_ L2 - http://Insights.ovid.com/pubmed?pmid=28267111 DB - PRIME DP - Unbound Medicine ER -