Suspected ophthalmic artery fat embolus following bilateral elbow liposuction

To present a rare case of a suspected ophthalmic artery fat embolus in a patient who underwent bilateral elbow liposuction.

The patient, a 44-year-old female with past smoking history and stable meningioma with no associated symptoms, presented with episodes of transient vision loss followed by a persistent "arc-like" scotoma in her left eye one month after bilateral elbow liposuction. Ophthalmic examination and imaging of the left eye revealed a visual acuity of 20/25, a paracentral scotoma, delayed perfusion, and decreased retinal thickness. A head and neck computerized tomography angiogram with intravenous contrast and diagnostic cerebral angiogram identified occlusion of the left ophthalmic artery. Following this, she received intra-arterial tissue plasminogen activator, after which her vision subjectively deteriorated, accompanied by an enlargement of the paracentral scotoma, the development of a new relative afferent pupillary defect, and additional areas of retinal ischemia. Coagulation studies, autoimmune studies, and echocardiogram imaging showed no remarkable findings, thereby decreasing the likelihood of other vascular or embolic etiologies. At her most recent follow-up visit, five months post-presentation, she reported no worsening of her symptoms or scotoma. Examination and imaging demonstrated stabilization of her ocular findings.

This case highlights the potential risk of ocular complications following non-facial cosmetic procedures, emphasizing the need for ophthalmologists to carefully review patients' cosmetic surgery histories when assessing unexplained visual symptoms.