Transient Sixth Nerve Palsy and Mydriasis following a Temporal Sculptra Aesthetic (Poly-(L)-Lactic Acid) Injection: A Case Report and Literature Review

Abstract

Introduction: Intraocular side effects of Sculptra Aesthetic (poly-(L)-lactic acid) (PLLA) (Dermik, Bridgewater, NJ, a subsidiary of Aventis Pharmaceuticals International Inc), dermal filler have been rare. The authors seek to describe the first case of a transient sixth nerve palsy and mydriasis secondary to extraorbital PLLA filler injection and to present hypotheses explaining the complications. Materials and Methods: A case report is presented that details a complication suffered by 1 patient during a temporal PLLA injection. A thorough review of the literature was performed. The literature was evaluated with respect to the number of patients, complications, and outcomes secondary to PLLA injections. Results: In the literature, there were 3 reported cases of ocular symptoms following a PLLA injection. The findings ranged from posterior ciliary artery occlusion to orbital infarction and blindness. In our case, we propose that the PLLA accessed the orbit by leakage through the temporal orbit due to the mechanism of injection combined with an increased porosity secondary to osteopenia. Conclusions: A large majority of the patients who seek a cosmetic result that can be gained by fillers are postmenopausal women. This population is characteristically affected by osteopenia and osteoporosis. For patients similar to ours, with osteopenia or osteoporosis, extra care must be taken when injecting the temporal area secondary to its various areas of susceptibility caused by decreased density. Because of the increased use of PLLA as a dermal filler, it would be prudent to include an eye exam as part of the pretreatment and posttreatment care plan.