Ocular Ischemia and Ischemic Oculomotor Nerve Palsy After Vascular Embolization of Injectable Calcium Hydroxylapatite Filler

Abstract

A healthy 25-year-old man who received a calcium hydroxylapatite filler injection for nose augmentation by a dermatologist suddenly developed blepharoptosis and orbital pain on the right side, associated with progressive visual disturbance of the right eye. Patchy necrosis at the nose and glabella, limitations of extraocular movements, and anterior segment ischemia, as evidenced by conjunctival injection, chemosis, corneal edema, dilated pupil, hyphema, and hypopyon, were noted. Orbital CT demonstrated linear deposits of a similar density to bone in the right medial orbit and eyelid, suggestive of multiple emboli along the conjunctival vessels. A provisional diagnosis of ocular ischemia and ischemic oculomotor nerve palsy secondary to vascular embolization was made. After 3 months, visual acuity, all intraocular inflammation, oculomotor nerve palsy, and skin necrosis resolved completely except for a dilated pupil.

Blindness following Cosmetic Injections of the Face

“…The injected substances included corticosteroids 16,18,21 and filler materials such as paraffin, 17 silicone oil, 19,22,28 bovine collagen, 20,23,30 polymethylmethacrylate, 24,25 hyaluronic acid, 26,31 and calcium hydroxyapatite. 29 The nose (root, 18,22,29 dorsum, 21,22,25,29 and tip 30,31 ) and the scalp 16,18 were the most frequently injected sites, with seven and three cases, respectively; whereas the remaining seven cases involved the forehead, 17,23 glabella, 24,27 glabella and cheek 20,26 (two cases for each area), and temple area 28 (one case). The syringe and needle used were described in only one case (25-gauge needle, 21 0.455 mm).…”

“…Seventeen patients 16 -31 (15 women and two men; mean age, 38 Ϯ 11.5 years; range, 24 to 65 years) who suffered transitory (three cases) 18,26,29 or permanent (14 cases) 16,17,19 -25,27,28,30,31 blindness following the injection of materials other than adipose tissue were identified ( Table 2). The injected substances included corticosteroids 16,18,21 and filler materials such as paraffin, 17 silicone oil, 19,22,28 bovine collagen, 20,23,30 polymethylmethacrylate, 24,25 hyaluronic acid, 26,31 and calcium hydroxyapatite.…”

Hydroxyapatite nanoparticles inhibit the growth of human glioma cells in vitro and in vivo

“…[17][18][19] Nano-HAP has little excitatory effect on blood vessels: nano-HAP medicine could be delivered by intravenous injection. 20,21 In this study, nano-HAPs were synthesized by the sol-coagel method, which had a good dispersive effect, and the very uniform size of nano-HAPS was about 50 nm, which had the advantages of providing high surface energy and so on. Hydroxyapatite nanoparticles were found capable of inhibiting the proliferation of tumor cells.…”

Ocular Ischemic Syndrome

“…In addition, OIS is occasionally caused by other conditions, and these include giant cell arteritis [ 9 -13 ], Takayasu's arteritis [ 14 -24 ], systemic lupus erythematosus [ 25 , 26 ], polyarteritis nodosa [ 27 ], scleroderma [ 28 ], after radiotherapy of nasopharyngeal carcinoma [ 29 ], and radiationinduced ocular ischemia [ 30 ]; it can occur after cerebral aneurysm repair surgery [ 31 ], after vascular embolization of injectable calcium hydroxylapatite fi ller for nose augmentation [ 32 ], following autologous refi ned fat injection into the glabellar area to treat wrinkles [ 33 ], hypoplasia of the internal carotid artery associated with neurofi bromatosis type 1 [ 34 ], arterial "steal" from…”