Ocular ischemia syndrome after aesthetic treatment with hyaluronic acid

A 49-year-old female with no pre-morbidities comes in with sudden, painless loss of vision in the left eye (OS) after a facial hyaluronic acid (HA) injection for aesthetic purposes one hour ago. Visual acuity was no light perception (NLP). OS examination revealed a mid-non-reactive mydriasis and complete ophthalmoplegia. Fundus examination of the OS suggested central retinal artery occlusion (CRAO). Systemic evaluation was normal. Given this diagnosis, ocular massage, anterior chamber paracentesis, anticoagulation, systemic antibiotherapy, and subcutaneous hyaluronidase around the injection sites and peribulbar region were performed. Despite these interventions, the patient did not regain vision, exhibiting signs of anterior and posterior ocular ischemia. Subsequently, she developed phthisis bulbi, necessitating evisceration. The management of this complication should be prompt, if possible, to mitigate its dire consequences.