Retinal Arteriole Occlusions Secondary to Silicone Microembolization

A patient with a history of mid-brain syndrome and silicone gluteal injection 12 years prior presented to the emergency department complaining of floaters in the right eye for the past week. Exam was notable for visual acuity of 20/60 in the right eye and 20/20 in the left eye. Intraocular pressures was 12 in both eyes. Anterior segment exam was unremarkable in both eyes. Posterior segment exam of the right eye revealed peripheral avascularity with dot-blot hemorrhages, preretinal hemorrhage, vitreous hemorrhage, and small hyperreflective retinal opacities throughout. Posterior segment exam of the left eye demonstrated dot-blot hemorrhages and peripheral avascularity with small hyperreflective retinal opacities. Optical coherence tomography demonstrated small hyperreflective opacities in the inner and outer retina. Fluorescein angiography demonstrated peripheral nonperfusion with leakage in both eyes. Humphrey visual field 30-2 and optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer were within normal limits in both eyes. The patient was administered intravitreal bevacizumab in the right eye. Hemoglobin electrophoresis was unremarkable. The patient eventually underwent peripheral laser photocoagulation in both eyes. Visual acuity improved to 20/20 in the right eye.

Presentation Date: 09/08/2022

Issue Date: 09/23/2022