Ophthalmic Artery Occlusion
Ophthalmic artery occlusion is very rare. Clinically, the disorder typically produces vision loss to the level of light perception or no light perception because simultaneous nonperfusion of the choroid and retina results in ischemia of all retinal layers. A cherry-red spot may not be present; both the inner retina and outer retina become opacified from the infarction, resulting in an absence of contrast difference between foveal and perifoveal retina that would produce such a spot.
Ophthalmic artery occlusion may be caused by dissection of the internal carotid artery, orbital mucormycosis, or embolization. An increasing number of ophthalmic artery occlusions caused by various cosmetic facial-filler injections, particularly into the periocular and brow area, have been reported, as popularity for such procedures has increased (Fig 6-21). In autopsy studies of patients who died during active GCA, up to 76% had some degree of ophthalmic artery affected by vasculitis; clinically, however, ophthalmic artery occlusion is rare in GCA.
Figure 6-21 Fundus photographic montage of the left eye of a 44-year-old woman following an ipsilateral injection of synthetic calcium hydroxylapatite gel into her left lateral lower eyelid for cosmetic purposes. Sudden loss of vision ensued to the level of no light perception. An ophthalmic artery occlusion occurred from presumed retrograde flow of the injectable cosmetic filler into the ophthalmic artery by way of anastomotic arteries in the orbit bridging the internal and external carotid circulations. The white filler material is visible in the retinal circulation and choroidal blood vessels.
(Courtesy of Kathryn Sun, MD, PhD, Thomas F. Essman, MD, and Brenda Schoenauer, CDOS.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.