Ophthalmic artery occlusion following local hyaluronic acid injection

Rationale: Ophthalmic artery occlusion (OAO) following hyaluronic acid (HA) injection is a rare but devastating complication of facial aesthetic procedures, often resulting in profound and irreversible visual loss. Due to its rarity and poor prognosis, standardized management of iatrogenic OAO remains limited. To our knowledge, long-term multimodal imaging follow-up of HA-induced OAO with integrated traditional Chinese and Western medicine treatment is rarely documented. Here, we report a case of OAO following nasal root HA injection and describe its clinical manifestations, multimodal imaging findings, and 10-month follow-up outcomes. Patient concerns: A 46-year-old female initially presented with sudden vision loss (no light perception) in the left eye and skin mottling after HA injection into the nasal bridge. After receiving intravenous dexamethasone and oxygen inhalation at a local hospital, she was transferred for interventional thrombolysis twice. However, no significant visual improvement was observed, and the patient was subsequently referred to our hospital for further diagnosis and treatment. Diagnoses: A definitive diagnosis of ophthalmic artery occlusion was not initially established at the first visit, where the patient was diagnosed with central retinal artery occlusion of the left eye. Upon presentation to our hospital, the left eye showed no light perception, intraocular pressure of 8 mm Hg, marked anterior segment inflammation, diffuse retinal edema, and a pale optic disc. Optical coherence tomography, flash visual evoked potential, electroretinography, and B-scan further confirmed the findings. Thus, the patient was diagnosed with left ophthalmic artery occlusion following HA injection. Interventions: Integrated traditional Chinese and Western medicine treatment, including anti-ischemic therapy, neuroprotection, herbal decoction, and acupuncture, was administered to the left eye. Outcomes: The visual acuity of the left eye remained no light perception throughout the follow-up. Scanning laser ophthalmoscopy demonstrated progressive retinal atrophy and proliferative membrane formation during the 9-month follow-up period. Lessons: Although iatrogenic ophthalmic artery occlusion following HA injection is rare, ophthalmologists should remain vigilant due to its poor prognosis and narrow therapeutic window. Standardized injection techniques and rigorous risk prevention measures should be prioritized to optimize patient safety.