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Local Anesthetics: Adverse Effects

Local Anesthetics: Adverse Effects

While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

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Orbital Infarction Syndrome Following Hyaluronic Acid Lip Filler Injection.

Fitz Gerald I Diala¹, Brian S Biesman², Jonathan M Pargament^3,4

¹Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Ophthalmic Plastic and Reconstructive Surgery

|September 23, 2025

Summary

This summary is machine-generated.

Hyaluronic acid filler injections can cause ophthalmic artery occlusion, leading to orbital ischemic syndrome. This case highlights a severe complication of cosmetic lip procedures, resulting in vision loss and enucleation.

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Area of Science:

Ophthalmology
Plastic Surgery
Vascular Medicine

Background:

Cosmetic procedures, such as lip filler injections, are increasingly popular.
Complications from dermal fillers, though rare, can be severe and vision-threatening.

Purpose of the Study:

To report the first case of orbital ischemic syndrome secondary to ophthalmic artery occlusion caused by hyaluronic acid lip filler injection.
To raise awareness among clinicians about this rare but devastating complication.

Main Methods:

A case report of a 31-year-old female with acute vision loss after lip filler injection.
Clinical examination, emergent neuroimaging, and ophthalmic assessments were performed.
Treatment included medical management (steroids, anticoagulants, vasodilators) and surgical interventions (lateral canthotomy/cantholysis, hyaluronidase injections).

Main Results:

The patient presented with severe vision loss (no light perception), ophthalmoplegia, and ptosis in the affected eye.
Despite prompt treatment, vision loss was irreversible, and the patient ultimately required enucleation due to intractable pain.
Ophthalmic artery occlusion leading to orbital infarction syndrome was diagnosed as the cause.

Conclusions:

Hyaluronic acid filler injection into the lip can lead to ophthalmic artery occlusion and subsequent orbital ischemic syndrome.
This case underscores the critical need for awareness and careful technique during filler injections to prevent catastrophic vascular complications.
Ophthalmologists and plastic surgeons should consider this diagnosis in patients presenting with acute vision loss after cosmetic facial procedures.