Orbital Infarction Syndrome Following Hyaluronic Acid Lip Filler Injection

A 31-year-old female presented with an acute onset of vision loss in the OS. On arrival to the hospital, OS ocular vitals were notable for no light perception vision, relative afferent pupillary defect, elevated intraocular pressure, ophthalmoplegia, and ptosis. Interval history was notable for lip filler injection. Emergent neuroimaging did not demonstrate large vessel occlusion. Ophthalmic artery occlusion resulting in orbital infarction syndrome was suspected. Patient received intravenous solumedrol, verapamil, aspirin, and lateral canthotomy/cantholysis, topical and intravenous antibiotics, and periorbital and orbital injections of hyaluronidase. With improvement in ptosis and extraocular motility, but vision remaining no light perception, the patient was discharged 5 days after presentation. However, a month later, the patient was enucleated due to intractable pain. This is the foremost report of orbital ischemic syndrome in the setting of ophthalmic artery occlusion secondary to hyaluronic acid filler injection to the lip.