Miliary microemboli of the retinal arterioles and choriocapillaris after subcutaneous injection of triamcinolone acetonide

To report a case of triamcinolone crystals associated miliary microemboli of the retinal arterioles and choriocapillaris. A 30-year-old woman with alopecia areata on her left auriculotemporal scalp, scheduled for 10 mg/ml triamcinolone acetonide steroid injections (maximum volume of 3 ml per session) for 1 month intervals, presented with a sudden decrease in vision in her left eye after 1 ml injection in a dermatology clinic. On ocular examination her best corrected visual acuity (BCVA) was hand movement in the left eye. Retinal examination showed multiple white-yellow steroid emboli in the superior and inferior temporal branch retinal arterioles which involves macula. Also there were diffuse yellow infiltrates in the choroid consistent with choroidal microemboli. Fluorescein angiography and optical coherence tomography images were suggestive for the retinal and choroidal ischemia. Subcutaneous triamcinolon injection may cause embolic occlusion of retinal and choroidal capillaries.