Ophthalmic artery occlusion following facial sclerosing therapy

To describe a case of ophthalmic artery occlusion and complete ophthalmoplegia after intralesional injection of a sclerosing agent into a subcutaneous hemangioma on the forehead.
Case Report: A 16-year-old girl underwent direct injection of 3 mL of sodium tetradecyl sulfate (Fibrovein) emulsion 1% (10 mg/mL) with a 23-gauge needle into a subcutaneous hemangioma on the forehead. Immediately after the injection, she developed sudden loss of vision and lid swelling of the left eye. Her visual acuity in the left eye became no light perception. Her left eye also developed a dilated pupil, ptosis, and complete external ophthalmoplegia. Funduscopy of the left eye revealed signs of central retinal artery occlusion. Magnetic resonance imaging of the orbit showed thickening of the medial and lateral rectus muscles of the left eye. Magnetic resonance venography of the brain was normal with no evidence of cavernous venous thrombosis. After 3 months, her ptosis and ophthalmoplegia resolved but her visual acuity remained no light perception.

Persistent total visual loss should be kept in mind as a disastrous complication of sclerosing therapy in a patient with facial hemangioma.