Research Letter |

Sudden Bilateral Vision Loss and Brain Infarction Following Cosmetic Hyaluronic Acid Injection

Ming-Shan He, MD1,2; Min-Muh Sheu, MD1,2; Zei-Lun Huang, MD1,2; Chen-Hsin Tsai, MD3; Rong-Kung Tsai, MD, PhD1,2
[+] Author Affiliations
1Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
2Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
3Department of Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan
JAMA Ophthalmol. 2013;131(9):1234-1235. doi:10.1001/jamaophthalmol.2013.1603.
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Periocular and paranasal injections of hyaluronic acid are increasingly common because it is purported to be a safe material for cosmetic implantation. Because of the multiple anastomoses between the vascular supply of the face and orbit, the potential for retrograde embolization of substances does exist.1 To our knowledge, we report the first case involving sudden bilateral vision loss and brain infraction following an injection of hyaluronic acid.

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Figure 1.
Injection Site and Fundus Photograph

A, The site of initial injection showed erythematous, violet reticular discoloration during the ensuing days. B, Pale optic disc and retinal whitening associated with the blood column are interrupted because of intra-arterial plugs after hyaluronic acid injection.

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Figure 2.
Diffusion-Weighted Magnetic Resonance Image of Brain and Visual Field

A, Diffusion-weighted magnetic resonance imaging of the brain demonstrated hyperintensity in the territory of the posterior, middle, and anterior cerebral artery, compatible with acute infarction. B, Visual field examination disclosed a left hemianopia in the left eye due to right parietal and occipital lobe infarction.

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