Central retinal artery occlusion associated with periocular corticosteroid injection for juvenile hemangioma

Intralesional corticosteroid injections are an accepted treatment for periocular juvenile hemangiomas. This treatment is felt to be relatively free of complications. We report, however, a case of central retinal artery occlusion associated with steroid injection for a periocular juvenile hemangioma in a four-year-old child. It is presumed that the force of injection or digital massage caused retrograde arterial flow, moving steroid suspension particles into the central retinal artery where vascular occlusion occurred. As a result of this case, our treatment regimen has been modified. We now use 0.1 cc steroid alloquats injected slowly through a 30-gauge needle and avoid firm digital pressure on the lesion.