Purpose: To report a case of accidental injection of hyaluronic acid into the corneal stroma through the upper eyelid during cosmetic surgery.
Case: A 34-year-old female had her upper eyelids filled with a hyaluronic acid injection at an aesthetic plastic-surgery clinic. Although the procedure was concluded without any ocular pain, she experienced decreased visual acuity in her left eye, and the left cornea was clouded immediately after the injection. She consulted a nearby doctor and was subsequently referred to our hospital. Upon initial examination, her left-eye visual acuity (VA) was counting fingers, with crevices caused by the hyaluronic acid injection found to exist in the corneal stroma. Although we initially expected that the hyaluronic acid would be naturally absorbed, no improvement occurred within 2 months after the initial examination. After an attempt to aspirate with a 30 G needle on an outpatient basis failed, aspiration, irrigation, and air injection into the anterior chamber were performed in the operating theater. At 5-months postoperatively, although slight corneal opacity remained, corrected VA improved to 0.4.
Conclusions: Our findings show that surgery is required to remove cosmetic hyaluronic acid when injected into the corneal stroma. Strict attention should be paid to prevent any mistake during cosmetic hyaluronic acid injection to avoid such serious complications.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 406-409, 2018.