Manuscript received on December 31, 2021; Revised on February 23, 2022; Accepted on March 1, 2022; Collection date of 2022.
This article is licensed under the Creative Commons Attribution License, allowing unrestricted use, distribution, and reproduction in any medium as long as the original work is cited.
Abstract
This research aimed to present a case of central retinal artery occlusion (CRAO) following rhinoplasty. A 22-year-old female encountered one-sided vision loss after rhinoplasty, having a history of temporary visual loss related to migraine aura and vasospasm. The patient showed no visual perception in the right eye, a 4 + relative afferent pupillary defect, disc swelling, macular cherry-red spot, and ischemic retina in the affected eye. Treatment involved anterior chamber paracentesis (AC tap), mannitol, and intravenous hydrocortisone, resulting in visual acuity improvement after two months.
Conclusion
A thorough medical history is essential in rhinoplasty surgeries, especially when dealing with patients with suspected vasospasm history.
1. Introduction
Rhinoplasty, a surgical procedure for aesthetics and function, carries risks, with acute, chronic, and functional complications documented in literature. While orbital and ophthalmic complications are rare, cases of blindness are primarily linked to central retinal artery occlusion. Prompt treatment and consideration of embolization in vasospasm cases due to local anesthetic injection are crucial.
2. Case Presentation
A 22-year-old female experienced sudden vision loss post-rhinoplasty for aesthetic purposes. The patient was diagnosed with Central Retinal Artery Occlusion (CRAO) and received timely treatment resulting in improved visual acuity after two months.
Figure 1.
Examination results including fundus photography, optical coherence tomography, and fluorescein angiography displayed characteristic signs of CRAO in the patient. Immediate medical intervention was essential for management.
The case highlights the importance of recognizing potential complications following cosmetic procedures. It serves as a reminder for healthcare professionals and patients to be aware of the risks involved and to seek prompt medical attention in case of any unexpected symptoms or complications.
3. Discussion
CRAO is a rare but serious condition that can result in partial or complete vision loss. It is essential to promptly diagnose and treat this condition to prevent permanent damage to the eye. Various factors such as vasoconstriction and emboli can cause CRAO, highlighting the importance of timely intervention for better patient outcomes.
The administration of adrenaline during rhinoplasty surgery is dependent on several factors, including the surgeon’s preferences, the duration of the procedure, and the level of bleeding from the nasal mucosa. It is crucial to consider any history of temporary vision loss in patients undergoing surgery, as this can indicate a predisposition to vasospasm. In our case, the patient’s migraine history was a significant factor, suggesting a potential link to vasospasm as the underlying cause of CRAO.
There is no standard treatment protocol for CRAO, with options such as decompression, lowering intraocular pressure, corticosteroids, and vasodilators being commonly used. The use of thrombolytics and hyperbaric oxygen therapy remains controversial and requires further research. While developing CRAO after rhinoplasty is rare, it is crucial to be aware of the potential risks, especially in young patients undergoing cosmetic procedures. Our case demonstrated an improvement in vision following treatment, underscoring the importance of careful consideration of anesthetics and vasoconstrictors in surgical procedures.
4. Conclusion
In summary, CRAO is a rare rhinoplasty complication, highlighting the necessity to prevent vasospasm and emboli during surgery. Surgeons should restrict vasoconstrictors for patients with a vasospasm history, while ophthalmologists must promptly manage this condition.
Data Availability
Data supporting the study is available through the corresponding author upon request. Please contact [corresponding author’s email address] for access to the data.
Consent
Authors have granted consent for the publication of photos and case history.
It is important to obtain consent from individuals before publishing any personal information or images. This ensures that individuals are aware of and agree to the use of their data. Authors have taken the necessary steps to obtain consent for the publication of photos and case history, respecting the privacy and rights of the individuals involved.
Conflicts of Interest
Authors declare no financial interest or conflicts of interest.
It is important for authors to disclose any potential conflicts of interest that may arise from their research or publication. This includes financial interests, such as funding from a company that could benefit from the research, or personal relationships that could bias their work. By declaring no conflicts of interest, authors assure readers that their work is unbiased and trustworthy.
References
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Associated Data
Data citations and availability upon request.
Data Availability Statement
Fundus autofluorescence (FAG) and optical coherence tomography (OCT) data supporting the study findings can be obtained from the corresponding author. Articles provided by Wiley.
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