Diagnosis and Treatment of an Ophthalmic Artery Occlusion During an Intralesional Injection of Corticosteroid Into an Eyelid Capillary Hemangioma

To demonstrate the usefulness of simultaneous indirect ophthalmoscopy in the diagnosis and treatment of embolization of the ocular circulation during intralesional injection of corticosteroids into capillary hemangiomas. A 4-month-old infant had an ophthalmic artery occlusion during an intralesional injection of corticosteroids into a right upper eyelid capillary hemangioma. The injection was discontinued immediately and a paracentesis was performed. Fluorescein angiography was performed 20 minutes and three weeks after the ophthalmic artery occlusion. Fluorescein angiography after the paracentesis showed delayed retinal and choroidal filling and large areas of retinal and choroidal ischemia. Three weeks after treatment, the angiographic abnormalities had resolved, and the retinal and choroidal circulations were normal. Twenty-eight months after treatment, the visual acuity was 20/20 in each eye. Ophthalmic artery occlusion can occur during intralesional injection of corticosteroids into capillary hemangiomas. Simultaneous indirect ophthalmoscopy allows the surgeon to discontinue the injection and provide treatment to allow for the best possible visual outcome after this complication.