Chung Caroline W, Shiuey Eric J, Briceño César A, Lee Vivian
Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Am J Ophthalmol Case Rep. 2023 May 20;31:101860. doi: 10.1016/j.ajoc.2023.101860. eCollection 2023 Sep.
Blindness is a well-known complication of filler injection in the glabellar region. Acute diplopia from filler injection without vision loss is a rare complication that typically results in clinical ophthalmoplegia which can have permanent sequelae. Here, we describe a patient who presented with acute diplopia with grossly intact full extraocular motility after glabella hyaluronic acid filler injection that resolved after 1 month.
A previously healthy 43-year-old woman underwent her first hyaluronic acid injection in the glabella and developed immediate binocular double vision with severe pain and skin mottling above her right eyebrow and central forehead. Hyaluronidase injections, nitroglycerin paste, and aspirin were immediately administered. On exam, there was significant skin mottling over the glabella, extending to the forehead and nose with a small incomitant horizontal and vertical misalignment. No changes to her vision were observed and extraocular motility was grossly full. The rest of her exam was unremarkable. Over the course of the following month, the patient's diplopia resolved, but she developed skin necrosis and scarring.
: Proper knowledge of facial and periocular anatomy is critical for practitioners to safely perform filler injections and manage potential complications. Patients should be counseled about the potential rare risks of these elective procedures.
失明是眉间区域填充剂注射的一种众所周知的并发症。注射填充剂后出现急性复视而无视力丧失是一种罕见的并发症，通常会导致临床性眼球运动麻痹，可能会有永久性后遗症。在此，我们描述一名患者，在眉间注射透明质酸填充剂后出现急性复视，但眼球外肌运动大致正常，1个月后复视症状消失。
一名43岁的既往健康女性首次在眉间进行透明质酸注射，注射后立即出现双眼复视，并伴有右眼眉上方及前额中部的剧痛和皮肤斑纹。立即给予透明质酸酶注射、硝酸甘油糊剂和阿司匹林。检查发现，眉间有明显的皮肤斑纹，延伸至前额和鼻部，伴有轻度非共同性水平和垂直斜视。未观察到视力变化，眼球外肌运动大致正常。其余检查无异常。在接下来的一个月里，患者的复视症状消失，但出现了皮肤坏死和瘢痕形成。
对面部和眼周解剖结构有充分了解，对于从业者安全进行填充剂注射和处理潜在并发症至关重要。应向患者告知这些择期手术可能存在的罕见风险。
