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Facial Ulcers and Restrictive Strabismus From Delayed Periorbital Granuloma After Poly-l–Lactic Acid Injection

Molly L. Fuller, MD, PhD1; Elizabeth A. Bradley, MD1
[+] Author Affiliations
1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2015;133(9):1090-1091. doi:10.1001/jamaophthalmol.2015.1666.
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This case report describes facial ulcers and strabismus occurring after dermal filler injection.

Complications of injectable fillers are uncommon but potentially devastating. Most adverse events occur soon after injection and are mild, including redness, itching, blanching, and nodule formation.1 More severe outcomes include soft-tissue necrosis, blindness, and anaphylaxis.2 Recently, numerous patients with histories of filler injection have developed delayed-onset granulomatous reactions and systemic inflammatory markers, a syndrome called autoimmune/inflammatory syndrome induced by adjuvants.3 Herein, we describe a patient with a nonhealing periorbital ulcer that progressed to orbital fibrosis. This presented a diagnostic dilemma owing to concurrent systemic inflammatory symptoms and a lack of reported history of facial fillers.

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Figure 1.
Clinical Appearance of the Patient

A, The saddle nose deformity (black arrowhead) and infraorbital ulcer (white arrowhead) seen at onset of the diplopia. B, Several months later after the diplopia had stabilized and with the patient’s daily dressings in place.

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Figure 2.
Histologic Evaluation of the Nonhealing Ulcer

Biopsy tissue from the inferior orbit showing the acellular, eosinophilic foreign material with surrounding inflammation, including foreign-body granulomas (hematoxylin-eosin). The material was birefringent under polarized light, consistent with poly-l–lactic acid.

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