Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

Abstract

We describe a young woman with patent foramen ovale who developed multiple retinal artery occlusion in the right eye after injection of hyaluronic acid into the nasal root. She reported a gradual decline in visual acuity, with visual field defects that had developed in two stages. Multiple retinal artery occlusion was confirmed by slit-lamp examination, dilated fundus examination, optical coherence tomography, visual field examination, and fundus fluorescein angiography. A patent foramen ovale was detected by electrocardiography, transesophageal echocardiography, and transthoracic sonography. The patient was treated with intravenous dexamethasone and cobamamide, as well as extracorporeal counterpulsation therapy; this approach has not been described in previous literature regarding retinal artery occlusion. The patient’s visual acuity improved from counting fingers at 30 cm to 20/133 within 3 days. Our report emphasizes the need for better understanding of vascular anatomy to minimize the risk of complications. Moreover, patients undergoing hyaluronic acid injection should receive information regarding the potential for mild and severe complications; relevant tests should be performed before surgery to exclude vulnerable patients. Finally, a nursing system is needed to facilitate the emergency recognition, triage, and management of retinal artery occlusion.

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“…After administration of antiplatelet therapy, his vision progressively improved during hospitalization, and the patient recovered well during follow-up. 61 Recently, Si and Wang 65 from our hospital reported an interesting 40-year-old female case presenting multiple RAOs following injection of hyaluronic acid as facial filler into the nasal root, which confirmed by a series of ophthalmologic examinations, and a PFO was determined by TEE. Fortunately, the patient's visual acuity improved quickly within 3 days after aggressive treatment.…”

“…Fortunately, the patient's visual acuity improved quickly within 3 days after aggressive treatment. 65 Compared with BRAO, CRAO may lead to a more severe outcome because the inner two-thirds of the retina lose their blood supply. 66 CRAO always presents as acute and permanent vision loss in one eye.…”