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Case Report

Embolic Central Retinal Artery Occlusion with Spared Cilio-Retinal Artery Caused by Triamcinolone Acetonide Suspension Injection into the Temporo- Mandibular Joint: Case Report and Review of Literature

Sanjiv Kumar Gupta, Department of Ophthalmology King George Medical University, Lucknow, Uttar Pradesh 226013, India , Sanjiv Kumar Gupta1 , Ajai Kumar2 , Siddhartha Bose3 , Preeti Singh4

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Ophthalmology and Allied Sciences 4(2):p 182-185, May - August 2018. | DOI: DOI: http://dx.doi.org/10.21088/oas.2454.7816.4218.26

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Abstract

We report a case of central retinal artery occlusion after Triamcinolone Acetonide suspension (TMA) injection into Temporomandibular joint (TMJ) and review of relevant literature. Case description: A 25-year old male presented with sudden painful vision loss in right eye immediately after TMA injection into right TMJ 24 hours prior to presentation. It was associated with transient dizziness and nausea. At presentation, his vision in the right eye was hand movement and projection of rays full. A complete ophthalmic examination was performed. Anterior segment examination was unremarkable, except for relative afferent pupillary defect in the right eye. Other than that, there was pale edematous retina with marked arteriolar thinning with intra-arterial TMA seen in few of the blocked arterioles and a cherry red spot at the macula. Treatment in form of ocular massage, hyperbaric oxygen therapy and oral Prednisolone (Omnacortil) 1.5mg/ kg as well as topical Difluprednate 0.05% (Diflucor), Bromfenac 0.09% (Unibrom) and Brimonidine 0.1% (Alphagan-P) was instituted, and patient was kept under observation for 1 week and followed up for one month, when the visual recovery was poor with final best corrected visual acuity at 6/60 on Snellen’s chart. Literature review: Several cases have been reported which show severe irreversible visual loss following intralesional corticosteroid injection in the head and neck area. Clinical relevance: Intra-articular injection into the TMJ should be given with caution

and informed consent for the same must be taken before the procedure as it may cause irreversible, sight-threatening complication. 
 
 
Keywords: Crao; Central Retinal Artery Occlusion; Triamcinolone Acetonide Suspension; Arterial Embolism; Vision Loss; Vascular Occlusion; Injection Complication.

 

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DOI: DOI: http://dx.doi.org/10.21088/oas.2454.7816.4218.26

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