Visual Impairment Following Periocular Triamcinolone Acetonide Injection into the Lacrimal Gland: A Case Report and Literature Review.

backgroundIdiopathic dacryoadenitis is a diagnosis of exclusion and may present with unilateral or bilateral eyelid swelling, erythema, pain, and characteristic S-shaped ptosis of the upper eyelid. Glucocorticoids remain the mainstay of treatment when symptoms are functionally limiting or clinically significant. Although local triamcinolone acetonide (TA) injection provides targeted anti-inflammatory effects with fewer systemic adverse effects, it carries a rare but potentially catastrophic risk of iatrogenic vascular embolization and acute vision loss.

methodsWe searched the PubMed database for relevant reports and herein describe the case of a 36-year-old woman with idiopathic dacryoadenitis who developed acute vision loss during lacrimal gland TA injection. She received immediate comprehensive treatment, including high-dose intravenous corticosteroid pulse therapy, vasodilators, neuroprotective agents, intraocular pressure-lowering medications, ocular massage, and supplemental oxygen. Her best-corrected visual acuity gradually recovered to 1.0 (20/20) at follow-up. DISCUSSION: Previous reports have described isolated cases of ophthalmic artery branch embolism after lacrimal gland TA injection, with most patients experiencing poor visual outcomes. Here, we report a case of complete visual recovery after such an injection. We compare this case with prior reports and discuss the possible pathogenic mechanisms, the therapeutic rationale, mechanisms of recovery, study limitations, and directions for future research.

conclusionIntraglandular triamcinolone administration for dacryoadenitis can cause severe vision loss. Although prompt multimodal management may restore vision, prognosis depends on treatment timing, embolic site, therapeutic choices, and individual patient factors. Reinforcing preventive precautions is essential to minimize this rare but potentially catastrophic risk. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .