Case Report: Bilateral vision-threatening anterior segment injury following periocular cosmetic high-intensity focused ultrasound
- 1Vietnam National Eye Hospital, Hanoi, Vietnam
- 2Clinical Research and Innovation Unit, Cung Hong Son International Eye Hospital, Hanoi, Vietnam
- 3Department of Ophthalmology, Bach Mai Hospital, Hanoi, Vietnam
Abstract
High-intensity focused ultrasound (HIFU) is widely used for noninvasive cosmetic rejuvenation, including periocular procedures. However, when performed near the globe, focused thermal energy may injure multiple anterior segment structures. We report a 38-year-old woman who developed acute bilateral ocular pain, redness, and blurred vision shortly after periocular cosmetic HIFU for eyelid fat reduction and facial rejuvenation. The right eye was more severely affected. At presentation, best-corrected visual acuity was counting fingers at 0.5 m in the right eye and 20/40 in the left eye, with intraocular pressures of 30 and 26 mmHg, respectively. Slit-lamp examination showed bilateral anterior uveitis, corneal edema, keratic precipitates, endothelial pigment deposits, diffuse iris stromal disruption with pigment dispersion, and focal lens opacities consistent with presumed thermal lens injury. After corneal edema improved, focal, tapered corneal opacities became visible, especially in the right eye. The cosmetic clinic reported use of a 1.5-mm focal-depth probe at 7.0 MHz with an energy setting of approximately 1 J/cm2; however, further procedural details were not available. The patient received topical and systemic anti-inflammatory treatments, intraocular pressure-lowering medications, hypertonic sodium chloride ointment, and supportive care. During follow-up, inflammation subsided and intraocular pressure stabilized without medication. At about 2 months, visual acuity was stable at 20/30 in the right eye and 20/25 in the left eye, although corneal, iris, and lens abnormalities remained. This case broadens the known range of cosmetic periocular HIFU-related ocular injuries by documenting a severe bilateral, multistructural anterior segment injury with acute ocular hypertension, diffuse iris stromal disruption, focal corneal opacities, and persistent focal lens opacities. It emphasizes the importance of conservative energy use during periocular procedures, ocular protection, trained operators, and prompt eye examinations if symptoms occur after the procedure.
Related
- Isolated Bilateral Periocular Lupus Miliaris Disseminatus Faciei: A Clinicopathological Mimicker of Granulomatosis With Polyangiitis.
- Point-of-Care Ultrasound Diagnosis of Retrobulbar Hematoma: A Sight-Threatening Emergency
- Bilateral Lateral Tarsal Artery Bypass and Free Flap Reconstruction of an Infected Gangrenous Heel in Chronic Limb-Threatening Ischemia: A Case Report of Three-Year Functional Limb Salvage
- Urinary and Sexual Function Outcomes After Ultrasound-Guided High-Intensity Focused Ultrasound for Uterine Fibroids: Associations of Lower Urinary Tract Symptoms with Fibroid Location and Uterine Morphology
- Target-dependent parameter-effect landscapes of low-intensity focused ultrasound neuromodulation in humans: a systematic review
BibTeX
@article{ho2026case,
title = {{Case Report: Bilateral vision-threatening anterior segment injury following periocular cosmetic high-intensity focused ultrasound}},
author = {Hai Xuan Ho and Thanh Ngoc Tran and Loan Thi Hoang and Nhu Thuy Pham and Thoa Thi Doan and Lan Huong Thi Tran and Hong Son Cung},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1891995},
url = {https://doi.org/10.3389/fmed.2026.1891995},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Bilateral vision-threatening anterior segment injury following periocular cosmetic high-intensity focused ultrasound
AU - Hai Xuan Ho
AU - Thanh Ngoc Tran
AU - Loan Thi Hoang
AU - Nhu Thuy Pham
AU - Thoa Thi Doan
AU - Lan Huong Thi Tran
AU - Hong Son Cung
PY - 2026
DA - 2026/10/21
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1891995
UR - https://doi.org/10.3389/fmed.2026.1891995
AB - High-intensity focused ultrasound (HIFU) is widely used for noninvasive cosmetic rejuvenation, including periocular procedures. However, when performed near the globe, focused thermal energy may injure multiple anterior segment structures. We report a 38-year-old woman who developed acute bilateral ocular pain, redness, and blurred vision shortly after periocular cosmetic HIFU for eyelid fat reduction and facial rejuvenation. The right eye was more severely affected. At presentation, best-corrected visual acuity was counting fingers at 0.5 m in the right eye and 20/40 in the left eye, with intraocular pressures of 30 and 26 mmHg, respectively. Slit-lamp examination showed bilateral anterior uveitis, corneal edema, keratic precipitates, endothelial pigment deposits, diffuse iris stromal disruption with pigment dispersion, and focal lens opacities consistent with presumed thermal lens injury. After corneal edema improved, focal, tapered corneal opacities became visible, especially in the right eye. The cosmetic clinic reported use of a 1.5-mm focal-depth probe at 7.0 MHz with an energy setting of approximately 1 J/cm2; however, further procedural details were not available. The patient received topical and systemic anti-inflammatory treatments, intraocular pressure-lowering medications, hypertonic sodium chloride ointment, and supportive care. During follow-up, inflammation subsided and intraocular pressure stabilized without medication. At about 2 months, visual acuity was stable at 20/30 in the right eye and 20/25 in the left eye, although corneal, iris, and lens abnormalities remained. This case broadens the known range of cosmetic periocular HIFU-related ocular injuries by documenting a severe bilateral, multistructural anterior segment injury with acute ocular hypertension, diffuse iris stromal disruption, focal corneal opacities, and persistent focal lens opacities. It emphasizes the importance of conservative energy use during periocular procedures, ocular protection, trained operators, and prompt eye examinations if symptoms occur after the procedure.
SN - 2296-858X
ER -