title: 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.
authors.affiliation: 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.
authors.forename: Xiu Zhuo
authors.initials: XZ
authors.lastname: Hu
authors.forename: Jun Yan
authors.initials: JY
authors.lastname: Hu
authors.forename: Peng Sen
authors.initials: PS
authors.lastname: Wu
authors.forename: Sheng Bo
authors.initials: SB
authors.lastname: Yu
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
mesh_terms: D000328:Adult; D001766:Blindness / Q000139:chemically induced; D019842:Ciliary Arteries; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000009:adverse effects*; D004617:Embolism / Q000139:chemically induced*; D005260:Female; D005546:Forehead; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D007279:Injections, Subcutaneous
chemical_list: D000067548:Dermal Fillers; D006820:Hyaluronic Acid