Ophthalmic artery occlusion following facial sclerosing therapy

Abstract

Purpose:To describe a case of ophthalmic artery occlusion and complete ophthalmoplegia after intralesional injection of a sclerosing agent into a subcutaneous hemangioma on the forehead.Case Report:A 16-year-old girl underwent direct injection of 3 mL of sodium tetradecyl sulfate (Fibrovein) emulsion 1% (10 mg/mL) with a 23-gauge needle into a subcutaneous hemangioma on the forehead. Immediately after the injection, she developed sudden loss of vision and lid swelling of the left eye. Her visual acuity in the left eye became no light perception. Her left eye also developed a dilated pupil, ptosis, and complete external ophthalmoplegia. Funduscopy of the left eye revealed signs of central retinal artery occlusion. Magnetic resonance imaging of the orbit showed thickening of the medial and lateral rectus muscles of the left eye. Magnetic resonance venography of the brain was normal with no evidence of cavernous venous thrombosis. After 3 months, her ptosis and ophthalmoplegia resolved but her visual acuity remained no light perception.Conclusion:Persistent total visual loss should be kept in mind as a disastrous complication of sclerosing therapy in a patient with facial hemangioma.

Bilateral Atypical Eyelid Lesions in a 50-Year-Old Woman

“…Sclerotherapy (choice A) is not the recommended next step because it is typically used for the treatment of orbital low-flow lymphovenous malformations, but it has not been studied for use in varicosities of the peripheral arcade . Moreover, sclerotherapy of orbital or facial lesions carries the risk of hemorrhage or embolic events in some cases . Surgical excision (choice B) is not preferred because the patient’s daily purging should be under better control before surgery is performed.…”

Sclerotherapy for eyelid and anterior orbital venous-lymphatic malformation

“…Fortunately, we did not have any problem in this regard, but our clinic was equipped with emergency setting table and CPR set. Rarely, disastrous vascular embolic events could happen following STS injections, and these serious complications should be discussed with the patient prior to performing the procedure 18 . To avoid this side effect, we used a small gauge needle after assurance of needle placement out of arterial lumen (with manual aspiration before injection).…”