Unilateral blindness after percutaneous injection sclerotherapy of orbital venous malformation presenting as orbital cellulitis

Abstract

This study pertains to a case of central retinal artery occlusion (CRAO) and complete unilateral blindness after intralesional injection of a sclerosing agent into orbital venous malformation (VM) presenting as orbital cellulitis. A 20-year-old female underwent a direct injection of 6 mg of bleomycin with a 23G needle into an orbital VM infiltrating the retrobulbar area and compressing the optic nerve. She was discharged without any complication after 24 h but reported back after 15 days with complete loss of vision in the right eye. Her visual acuity in the right eye was reduced only to perception of light. Fundoscopy of the right eye revealed signs of CRAO. Magnetic resonance imaging of the orbit showed a decrease in the size and enhancement of orbital VM. After 2 weeks, her visual acuity remained up to light perception. Permanent visual loss should be kept in mind as a disastrous complication of sclerosing therapy in a patient with orbital and paraorbital VM encroaching the retrobulbar area. In addition, orbital venolymphatic malformations may present as orbital cellulitis.