Cosmetic Filler Blindness: Recovery After Repeated Hyaluronidase Injections

2021 ◽  
Author(s):  
Jennifer J Danks ◽  
James D Dalgliesh ◽  
Tom Ayton
Keyword(s):  
Hyaluronic Acid ◽  
Best Practice ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
High Dose ◽  
Clinical Scenarios ◽  
Cherry Red Spot ◽  
Delayed Recognition

Abstract Background The rise of cosmetic injectables has seen new clinical scenarios related to complications. The scenario of hyaluronic acid (HA) aesthetic interventional induced visual loss (AIIVL) has become more recognized. While this complication is rare, there can be delayed recognition and treatment, with limited opportunity to evaluate potential treatments and establish best practice guidelines. Objectives We report a case of documented visual recovery with extra-orbital and intra-orbital hyaluronidase. Central retinal artery occlusion (CRAO) is an ischemic event requiring urgent intervention. We hope to assist protocols being developed for HA AIIVL. Methods Following loss of vision, 675 international units (IU) of hyaluronidase was given immediately to the injection site and extra-orbital area. Within four hours, 3,000 IU intra-orbital and 1,500 IU extra-orbital hyaluronidase was given in the Emergency Department (ED). Results Visual loss in a 38-year-old female, following ipsilateral glabella and nasal injection of 0.15 ml of hyaluronic acid filler Juvéderm Voluma via the nasal tip, was documented at no perception of light (NPL) with afferent pupil defect (APD), CRAO, fundoscopy showing a cherry red spot. This was associated with cerebral irritation and Magnetic Resonance Imaging (MRI) ischemia. Hyaluronidase was injected as described above. The following day, visual acuity (VA) in the affected eye recovered to 6/18 with a relative superior visual field scotoma. VA improved to 6/6 at one month. Conclusions We believe immediate injection, followed by high dose intra-orbital and extra-orbital injection of hyaluronidase, had a positive effect in this case. Recovery of vision was remarkable, from NPL to 6/6, documented at a tertiary referral eye hospital.

scholarly journals Central Retinal Artery Occlusion Associated with Sildenafil Overdose

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Mojtaba Abrishami ◽  
Seyedeh Maryam Hosseini ◽  
Hamid Mohseni ◽  
Majid Razavi ◽  
Amir Ghaffarian Mashhadi Nejad ◽  
...  
Keyword(s):  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Limited Area ◽  
Predisposing Factor ◽  
Cherry Red Spot ◽  
Retinal Artery ◽  
The Right

Background. To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. Conclusion. CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.

Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cephalalgia ◽  
2021 ◽  
pp. 033310242110562
Author(s):  
Nikita Chhabra ◽  
Chia-Chun Chiang ◽  
Marie A Di Nome ◽  
Odette Houghton ◽  
Rachel E Carlin ◽  
...  
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Monocular Vision ◽  
Ischemic Optic Neuropathy ◽  
Migrainous Infarction ◽  
Ischemic Complications ◽  
History Of

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

Bilateral Central Retinal Artery Occlusion in Infective Endocarditis

2020 ◽  
pp. 247412642096090
Author(s):  
Mohamed Mohamed ◽  
Tahira Scholle
Keyword(s):  
Infective Endocarditis ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Motion Vision ◽  
Hand Motion ◽  
Cherry Red Spot ◽  
Retinal Artery

Purpose: This report describes a patient with bilateral, sequential central retinal artery occlusions (CRAOs) due to infective endocarditis (IE). Methods: A case report is presented. Results: A 35-year-old man with IE who recently completed a course of intravenous antibiotic therapy presented with sudden right-eye vision loss. Examination revealed hand motion vision, a cherry-red spot in the macula in the right eye, and an embolus in the inferotemporal arcade of the left eye. The diagnosis of right-eye CRAO secondary to IE was made, with the presumed source being his dental caries. The patient was admitted with plans for aortic valve replacement and dental extraction. During his hospitalization, the patient suffered from a CRAO in his left eye, resulting in bilateral loss of vision. Conclusions: IE can have severe embolic complications; prompt diagnosis and treatment medically and surgically are necessary to reduce further morbidity and mortality.

Central retinal artery occlusion from Streptococcus gallolyticus endocarditis

2020 ◽  
Vol 13 (9) ◽  
pp. e235763
Author(s):  
Rita Serras-Pereira ◽  
Diogo Hipolito-Fernandes ◽  
Luísa Azevedo ◽  
Luísa Vieira
Keyword(s):  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Transoesophageal Echocardiography ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Streptococcus Gallolyticus ◽  
Cardiovascular Comorbidities ◽  
Cherry Red Spot ◽  
Retinal Artery

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.

scholarly journals A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Fernando Montenegro Sá ◽  
Sara I. L. Fernandes ◽  
Rita J. R. Carvalho ◽  
Luís M. G. Santos ◽  
José A. S. Antunes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Transoesophageal Echocardiography ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Acute Visual Loss ◽  
History Of ◽  
Retinal Artery

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.

Vision loss in giant cell arteritis

2021 ◽  
pp. practneurol-2021-002972
Author(s):  
Laura Donaldson ◽  
Edward Margolin
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Ischaemic Optic Neuropathy ◽  
Ciliary Arteries ◽  
Retinal Artery

Almost two-thirds of patients with giant cell arteritis (GCA) develop ocular symptoms and up to 30% suffer permanent visual loss. We review the three most common mechanisms for visual loss in GCA, describing the relevant ophthalmic arterial anatomy and emphasising how ophthalmoscopy holds the key to a rapid diagnosis. The short posterior ciliary arteries supply the optic nerve head, while the central retinal artery and its branches supply the inner retina. GCA has a predilection to affect branches of posterior ciliary arteries. The most common mechanism of visual loss in GCA is anterior arteritic optic neuropathy due to vasculitic involvement of short posterior ciliary arteries. The second most common cause of visual loss in GCA is central retinal artery occlusion. When a patient aged over 50 years has both anterior ischaemic optic neuropathy and a central retinal artery occlusion, the diagnosis is GCA until proven otherwise, and they should start treatment without delay. The least common culprit is posterior ischaemic optic neuropathy, resulting from vasculitic involvement of the ophthalmic artery and its pial branches. Here, the ophthalmoscopy is normal acutely, but MR imaging of the orbits usually shows restricted diffusion in the optic nerve.

Efficacy of Thrombolytic, Laser, Anti-VEGF and Surgical Treatment in Retinal Artery Occlusion and Related Complications

2020 ◽  
pp. 26-30
Keyword(s):  
Surgical Treatment ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Arterial Blood Flow ◽  
Treatment Methods ◽  
Arterial Blood ◽  
Anti Vegf ◽  
Retinal Artery

Retinal artery occlusion (RAO) is characterized by the sudden interruption of arterial blood flow in the retinal circulation and subsequent ischemic retinal injury. Retinal artery occlusion is divided into sub-forms such as central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). Patients with CRAO present with sudden, painless, and unilateral complete visual loss, while patients with BRAO present with partial or complete visual loss in relation to visual field damage. Thromboembolism is the non-arteritic form and the predominant mechanism in RAO; the form defined as arteritic RAO constitutes approximately 5% and is associated with inflammatory changes. Retinal artery occlusion is an ophthalmologic emergency where the most important factor in its treatment is time and the early interventions are very important. The conventional treatment methods aim to restore perfusion by reducing intraocular pressure or vasodilatation and to reduce ischemic damage. In order to achieve more accurate results in treatment, methods to directly open the obstruction caused by thromboembolism have been tried. These include thrombolytic therapy, laser, and surgical treatment. At the same time, studies on the efficacy of anti-VEGF treatment in emerging complications are ongoing.

Sign in / Sign up

Export Citation Format

Share Document