Occlusion Of Multiple Branches Of The Ophthalmic Artery After Injection Of Triamcinolone Into The Nasal Septum

Purpose: We report a case of visual loss caused by occlusion of multiple branches of the ophthalmic artery after triamcinolone injection into the nasal septum.Case summary: A 62-year-old male was referred to our ophthalmology clinic because of marked loss of vision in the right eye immediately after triamcinolone injection into the nasal septum. His corrected visual acuity was hand motion in the right eye and the intraocular pressure was 20 mmHg. His pupil was mid-dilated, fixed, and did not respond to light. Fundus examination revealed multiple, white steroidal emboli in the terminal retinal artery and capillaries. Fundus photography revealed macular edema, ischemic retinal whitening, and a cherry-red spot in the posterior pole of the retina. Optical coherence tomography (OCT) revealed inner-layer whitening and swelling and OCT-angiography revealed reduced numbers of terminal capillaries and a low vascular density. Anterior chamber paracentesis and ocular massage were immediately performed. Wide fluorescein angiography revealed diffuse choroidal hypofluorescence in the early phase and fluorescein leakage around the posterior pole in the late phase. Visual acuity improved to 1.0, but retinal whitening was still evident below the macula on fundus examination 3 months after symptom onset.Conclusions: Multiple branches of the ophthalmic artery may become occluded after an intranasal, septal triamcinolone injection. The condition improves with immediate management.