Vitreous hemorrhage and Rhegmatogenous retinal detachment that developed after botulinum toxin injection to the extraocular muscle: case report

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Abstract

Background

The authors report a case of a rare complication that occurred after botulinum toxin injection to the extraocular muscle, which was easily overlooked and successfully corrected by surgery.

Case presentation

A 34-year-old female patient visited our clinic for diplopia and ocular motility disorder after removal of an epidermoid tumor of the brain. At her initial visit, her best-corrected visual acuity (BCVA) was 20/20 for both eyes. An alternate cover test showed 45 prism-diopter esotropia and 3 prism-diopter hypertropia in the right eye. Following 6 months of observation, the deviation of the strabismus did not improve, and botulinum toxin was injected into the right medial rectus (RMR). After 6 days, she visited our clinic with decreased visual acuity of her right eye. The BCVA was found to be 20/50 for her right eye. Funduscopic examination presented a retinal tear inferonasal to the optic disc with preretinal hemorrhage. Subretinal fluid nasal to the fovea was seen on optical coherence tomography (OCT). Barrier laser photocoagulation was done around the retinal tear; however, her visual acuity continued to decrease, and vitreous hemorrhage and subretinal fluid at the lesion did not improve. In addition, a newly developed epiretinal membrane was seen on OCT. An alternate cover test presented 30 prism-diopter right esotropia. 19 weeks after RMR botulinum toxin injection, she received pars plana vitrectomy, membranectomy, endolaser barrier photocoagulation, and intravitreal bevacizumab (Avastin®) injection. After 4 months, her visual acuity improved to 20/20, and only 4 prism-diopter of right hypertropia and 3 prism-diopter of exotropia were noted. Vitreous opacity and the epiretinal membrane were completely removed, as confirmed by funduscopic and examination.

Conclusions

Sudden loss of vision after injection of botulinum toxin into the extraocular muscle may suggest a serious complication, and a prompt, thorough ophthalmic examination should be performed. If improvements are not observed, rapid surgical intervention is recommended to prevent additional complications.

Electronic supplementary material

The online version of this article (10.1186/s12886-017-0649-2) contains supplementary material, which is available to authorized users.

Related collections

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Author and article information

Contributors

Dong Hyun Lee: wizmeca@live.co.kr

Jinu Han: jinuhan@yuhs.ac

Sueng-Han Han: shhan222@yuhs.ac

Sung Chul Lee: sunglee@yuhs.ac

Min Kim:

ORCID: http://orcid.org/0000-0003-1873-6959

+82-2-2019-3445 , minkim76@gmail.com

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 13 December 2017

Publication date PMC-release: 13 December 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 249

Affiliations

[1 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Institute of Vision Research, Department of Ophthalmology, Severance Eye and ENT Hospital, , Yonsei University College of Medicine, ; Seoul, South Korea

[2 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Department of Ophthalmology, Gangnam Severance Hospital, , Yonsei University College of Medicine, ; Seoul, South Korea

Author information

Min Kim http://orcid.org/0000-0003-1873-6959

Article

Publisher ID: 649

DOI: 10.1186/s12886-017-0649-2

PMC ID: 5729414

PubMed ID: 29237498

SO-VID: 3d7445b2-bf0b-4e33-a66a-4836f5653864

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.