Retina and optic nerve complications and hearing injury caused by Sclerotherapy of Facial Vascular Malformation

This report describes a complication of symptoms consistent with transiency visual acuity damage and hearing injury following sclerotherapy with a polidocanol injection to a facial vascular malformation. After the direct injection of 5cc polidocanol-room air emulsion into the subcutaneous malformation, a 3-year-old boy developed bilateral eyelid swelling the next day, and on 7 days later at referral, visual acuity in the left eye was light perception. Fundoscopy revealed retinal hemorrhage; fluorescein angiography (FA) disclosed hyperreflective leakage on the optic disk 15 days later, and OCT showed nerve fiber edema between the disk and macular. The orbital magnetic resonance imaging (MRI) demonstrated the normal extraocular muscles. In a month later, bilateral eyelid swelling resolved but the visual acuity remained 20/500, and 20/20 in two months later, but the hearing injury remained. It needs much more special attention in sclerotherapy for facial malformation because the sclerosants may cause severe toxicity or inflammation in retina and optic nerve, resulting in transiency visual acuity damage and acoustic nerve injury. The related examination including ophthalmic investigation after the sclerotherapy is necessary.