Anterior Segment Ischemia and Retinochoroidal Vascular Occlusion After Intralesional Steroid Injection

Abstract

A 19-year-old woman was admitted with sudden severe pain and loss of light perception that began immediately after eyelid injection of the depot form of corticosteroid. Ecchymosis of the lower eyelid, corneal edema, and a fixed dilated pupil were noted. Fundus examination could not be performed because of corneal edema. Embolic material packed in the episcleral vessels was detected. With these findings, the diagnosis was anterior and posterior segment ischemia. Despite administration of an intravenous hyperosmotic agent, in addition to topical and systemic pulse corticosteroid (1.0 g/day), vision was not recovered. The most serious complication of intralesional injection of corticosteroid is vascular occlusion. This catastrophic complication after intralesional steroid injection should prompt immediate ophthalmoscopic fundus examination to allow early recognition of ischemic signs and immediate intervention.

Blindness following Cosmetic Injections of the Face

“…A single case of visual impairment subsequent to the use of nasal decongestant was also excluded. 44 All articles that described cases in which facial injection had no pure cosmetic aim, such as sclerotherapy of vascular lesions [45][46][47][48][49][50][51] and corticosteroid injections for the treatment of chalazia, 52,53 were excluded.…”

Comparison of the effectiveness of intralesional triamcinolone acetonide injection vs. incision and curettage techniques in the treatment of chalazion

“…Kortikosteroidler myoflamentlerde kalsiyum mobilizasyon ve duyarlılığını arttırarak, vasküler dilatasyondan sorumlu nitrik oksit sentezini azaltarak ve vasküler tonusu arttırarak diğer vasküler sebeplere bağlı komplikasyonların oluşmasına da sebep olurlar (16)(17). Enjeksiyona bağlı olarak; kapak cildinde depigmentasyon ve intraepidermal depozit gibi basit komplikasyonlar yanında, retinal ve koroidal vasküler oklüzyon, iris depigmentasyonu, cerrahi gerektiren korneal perforasyon, travmatik katarakt, iris depigmentasyonu, göz içi basıncında artış, ön segment iskemisi, korneaskleral ve konjonktival erime, yağ dokuda atrofi gibi ciddi komplikasyonlar da görülebilmektedir (7)(8)(9)14,(18)(19)(20)(21)(22)(23). Literatürde düşük (%1-6) oranlarda bildirilen kapak cildi depigmentasyonunu %16 gibi bir oranda tespit eden Alpay ve ark.…”

Management of marginal chalazia: a surgical approach

“…However, a combination of incision and drainage with intralesional steroid injection may be particularly useful in chronic non-marginal chalazia 9. Steroid injection after chronic chalazion surgery must always be administered with the chalazion clamp still in situ to maximise access of the steroid to any residual granuloma9 and to prevent the possibility of steroid embolisation with selected ocular ischaemia via anastomotic vessels 6 7 10…”