Research

Medial Posterior Ciliary Artery Occlusion after Facial HA-CaHA Injection

AAO Journal4d ago1 min read

A 25-year-old woman had sudden-onset vision loss and a visual acuity of 20/80 in the right eye while receiving hyaluronic acid-calcium hydroxylapatite (HA-CaHA) injection at the root of her nose during rhinoplasty. Funduscopy 14 days after the injection showed a pale optic nerve head (ONH) and diffuse pigment alteration of the peripheral nasal and inferior retina (A). Indocyanine green angiography revealed a filling defect in the nasal half of the choroid, normally perfused by the medial posterior ciliary artery that also supplies the optic nerve (B).

Read full article on AAO Journal

AI Summary

Quick Take

A 25-year-old woman suffered sudden vision loss (20/80) during a rhinoplasty procedure involving hyaluronic acid-calcium hydroxylapatite (HA-CaHA) filler injection at the root of the nose. Imaging confirmed a medial posterior ciliary artery (MPCA) occlusion, characterized by a pale optic nerve head and significant choroidal filling defects.

Why It Matters

This case underscores the severe vascular risks associated with facial fillers, particularly in the 'danger zones' around the nose where arterial anastomoses are common. While central retinal artery occlusion is often the primary concern, this case demonstrates how filler material can embolize specifically into the ciliary circulation, affecting both the optic nerve and the choroid. As the popularity of non-surgical rhinoplasty grows, eye care providers must be vigilant in recognizing these rare but devastating embolic complications that can occur even in young, healthy patients.

Key Findings

Sudden-onset vision loss occurred immediately during the injection of HA-CaHA at the nasal root, resulting in a visual acuity of 20/80.
Fundus examination 14 days post-injection showed a pale optic nerve head and diffuse pigment alteration in the peripheral nasal and inferior retina.
Indocyanine green angiography (ICGA) revealed a clear filling defect in the nasal half of the choroid, indicating a lack of perfusion.
The clinical presentation was consistent with an occlusion of the medial posterior ciliary artery, which provides the blood supply to both the nasal choroid and the optic nerve.

Practice Implications

Clinicians should treat any sudden vision loss following facial cosmetic injections as a vascular emergency. Patients presenting with these symptoms require immediate ophthalmic evaluation, including funduscopy and potentially ICGA, to identify the specific vascular territory affected and to coordinate urgent care.

Who's Affected

Retina SpecialistsComprehensive OphthalmologistsOptometristsCosmetic SurgeonsDermatologists

Evidence StrengthPreliminary

AI-generated summary — always read the original source for full context

Discussion

No comments yet. Be the first to share your thoughts.