title: A case report of ophthalmic artery emboli secondary to Calcium Hydroxylapatite filler injection for nose augmentation- long-term outcome.
abstract: BACKGROUND
  Filler injection for face augmentation is a common cosmetic procedure in the last decades, in our case report we describe long-term outcomes of a devastating complication of ophthalmic artery emboli following Calcium Hydroxylapatite filler injection to the nose bridge.
  
  
  METHODS
  A healthy 24-year-old women received a Calcium Hydroxylapatite filler injection to her nose bridge for the correction of nose asymmetry 8 years post rhinoplasty. She developed sudden right eye ocular pain and visual disturbances. Visual acuity was 20/20 in both eyes and visual field in the right eye showed inferior arch with fixation sparing and supero-temporal central scotoma. Examination revealed marked periorbital edema and hematoma, ptosis, ocular movements limitation, an infero-temporal branch retinal artery occlusion and multiple choroidal emboli. Eighteen months post initial presentation ptosis and eye movements returned normal and choroidal emboli absorbed almost completely. However, visual acuity declined to 20/60, visual field showed severe progressive deterioration with a central and supero-nasal field remnant and the optic disc became pallor.
  
  
  CONCLUSIONS
  Cosmetic injection of calcium hydroxylapatite to the nose bridge can result in arterial emboli to the ophthalmic system with optic nerve, retinal and choroidal involvement causing long term severe visual acuity and visual field impairment.
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel. coheneyal123@gmail.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Yatziv
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Igal
authors.initials: I
authors.lastname: Leibovitch
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Kesler
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Ran Ben
authors.initials: RB
authors.lastname: Cnaan
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Ainat
authors.initials: A
authors.lastname: Klein
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Goldenberg
authors.affiliation: Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Habot-Wilner
mesh_terms: D001672:Biocompatible Materials / Q000009:adverse effects*; D002829:Choroid / Q000098:blood supply; D003357:Cosmetic Techniques / Q000009:adverse effects*; D017886:Durapatite / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D009666:Nose / Q000601:surgery; D009880:Ophthalmic Artery; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D017886:Durapatite
keywords: Branch retinal artery occlusion; Calcium hydroxylapetite filler; Choroidal emboli; Ophthalmoplegia; Visual field