title: Choroid vascular occlusion and ischemic optic neuropathy after facial calcium hydroxyapatite injection- a case report.
abstract: BACKGROUND
  We reported a case of sudden monocular vision loss after calcium hydroxyapatite (CaHA) injection into the nasal tip and dorsum with detailed retina images.
  
  
  METHODS
  A healthy, 35-year-old woman received CaHA filler injection for nose augmentation. Ten minutes after the procedure, she developed nausea, vomiting, headache, ptosis, and left periorbital pain. After 30 minutes, she complained of progressively blurring vision in the left eye. The best-corrected visual acuity (BCVA) in her left eye was 30 cm ahead of hand motion. Left exotropia was noted in primary gaze. Limitations in adduction, supraduction, and infraduction of the left eye were also observed. Slit lamp examination of the left eye revealed a pink conjunctiva, a clear cornea, a mild anterior chamber reaction, a sluggish papillary light reflex, and a semi-dilated pupil. A positive relative afferent pupillary defect was observed in the left eye. Fundus examination revealed optic disc edema and some linear whitish opacity over the superior and temporal sites in the left eye, suggesting multiple CaHA emboli in the choroid vessels.
  
  
  CONCLUSIONS
  Although the majority of adverse reactions are mild and transient, surgeons should be alert about extremely rare serious adverse events such as visual loss.
authors.affiliation: Department of Ophthalmology, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Chou
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsin-Han
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
authors.forename: Yi-Yu
authors.initials: YY
authors.lastname: Tsai
authors.affiliation: Department of Ophthalmology, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
authors.forename: You-Ling
authors.initials: YL
authors.lastname: Li
authors.affiliation: Department of Ophthalmology, China Medical University Hospital, No. 2 Yuh Der Road, Taichung, 404, Taiwan. irisluu2396@gmail.com.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. irisluu2396@gmail.com.|School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan. irisluu2396@gmail.com.
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000139:chemically induced* / Q000150:complications; D019842:Ciliary Arteries; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D017886:Durapatite / Q000008:administration & dosage / Q000009:adverse effects*; D005145:Face; D005260:Female; D006801:Humans; D007267:Injections; D018917:Optic Neuropathy, Ischemic / Q000139:chemically induced* / Q000150:complications
chemical_list: D000067548:Dermal Fillers; D017886:Durapatite