Ocular and cerebral infarction from periocular filler injection

A 20-year-old woman presented with loss of vision in her right eye and a "black nose" after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dil...

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Bibliographic Details
Published in:Orbit (Amsterdam) 2019-08, Vol.38 (4), p.322-324
Main Authors: Ansari, Zubair A, Choi, Catherine J, Rong, Andrew J, Erickson, Benjamin P, Tse, David T
Format: Article
Language:English
Subjects:
Acute Disease
Arterial Occlusive Diseases - chemically induced
Arterial Occlusive Diseases - diagnostic imaging
Blindness - chemically induced
Dermal Fillers - adverse effects
Female
Fluorescein Angiography
Humans
Hyaluronic Acid - adverse effects
Infarction, Anterior Cerebral Artery - chemically induced
Infarction, Anterior Cerebral Artery - diagnostic imaging
Injections, Intradermal
Magnetic Resonance Imaging
Ophthalmic Artery - drug effects
Ophthalmic Artery - pathology
Retinal Artery Occlusion - chemically induced
Retinal Artery Occlusion - diagnostic imaging
Skin Aging - drug effects
Tomography, Optical Coherence
Viscosupplements - adverse effects
Young Adult
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Summary:A 20-year-old woman presented with loss of vision in her right eye and a "black nose" after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dilated fundus exam showed a fibrotic membrane emanating from a pale optic nerve and a diffusely atrophic retina with sclerotic vessels. An MRI demonstrated scattered right-sided parietal lobe infarcts. These findings were consistent with inadvertent cannulation of the supraorbital artery, followed by injection of filler into the internal carotid circulation. The product traveled in a retrograde fashion, occluding the right ophthalmic artery, right dorsal nasal artery, and arterial segments to the Circle of Willis. This case highlights the importance of understanding the complex vascular architecture of the periorbita and the mechanism by which such occlusions occur.
ISSN:0167-6830
1744-5108
DOI:10.1080/01676830.2018.1537287