Intraocular Inflammation Following Inadvertent Intraocular Injection of Botulinum Toxin A: A Case Report and Literature Review
Author: Akshay Nair
Base Hospital / Institution: Dr Agarwals Group of Eye Hospitals, Mumbai India
ePoster presentation
Abstract ID: 25-346
Purpose
This case report and literature review aims to elucidate the clinical course, mechanisms, and outcomes of a rare complication—severe intraocular inflammation and ischemic retinopathy—following inadvertent intraocular injection of botulinum toxin A (BTA) during periocular treatment for benign essential blepharospasm.
Methods
A retrospective case review was conducted for a 49-year-old female who developed painless vision loss, vitritis, and retinal ischemia one week after inadvertent intraocular BTA injection. Clinical data, including slit-lamp examination, optical coherence tomography (OCT) angiography, and treatment outcomes, were analyzed. A systematic literature review was performed using PubMed and Scopus databases, focusing on cases of intraocular BTA injection complications (2000–2023). Data from 14 relevant studies were extracted and compared to contextualize the current case’s novelty, particularly its inflammatory and ischemic features. Pathophysiological hypotheses were developed through synthesis of animal studies, clinical reports, and vascular autoregulation theories.
Results
The patient presented with counting fingers vision, anterior chamber inflammation, vitritis, and posterior synechiae in the affected eye. OCT angiography revealed foveal ischemia, capillary non-perfusion, and temporal retinal thinning, indicating irreversible ischemic damage. Despite declining vitrectomy, medical management with oral/topical steroids, antibiotics, and cycloplegics led to partial resolution of inflammation, with vision stabilizing at 6/18 at six months.
Conclusion
Inadvertent intraocular BTA injection, though rare, can precipitate severe intraocular inflammation and ischemic retinopathy, leading to permanent vision loss. While steroids and antibiotics may mitigate acute inflammation, surgical options like vitrectomy should be considered if vitritis persists. Future research should explore BTA’s direct effects on retinal vasculature and inflammatory pathways to optimize management protocols.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Maneesh | Bapaye | Dr Bapaye Eye Hospital, Nashik, India |
