From the Guidelines
The potential complication of injecting a long-acting steroid, such as triamcinolone (Kenalog), into the inferior turbinate is permanent vision loss due to cavernous vein thrombosis, which has been reported in 0.006% of patients. This serious complication occurs because the inferior turbinate has a rich vascular supply that communicates with the ophthalmic artery through anastomoses. If steroid particles enter these vessels and travel retrograde to the ophthalmic circulation, they can cause embolic occlusion of retinal arteries, resulting in immediate and potentially permanent vision loss, as noted in the study by 1.
Some key points to consider when injecting steroids into the inferior turbinate include:
- The use of proper technique, including aspiration before injection, to minimize the risk of complications
- Avoiding excessive pressure during injection, which can increase the risk of steroid particles entering the vascular supply
- Considering the use of non-particulate steroids when possible, to reduce the risk of embolic occlusion
- Being aware of the potential for other complications, such as local infection, septal perforation, and mucosal atrophy, although these are generally less severe than the vascular complications, as discussed in the study by 1.
The study by 1 highlights the importance of careful consideration and proper technique when injecting steroids into the inferior turbinate, in order to minimize the risk of serious complications such as permanent vision loss.
From the Research
Potential Complications of Injecting Long-Acting Steroids into the Inferior Turbinate
- Blindness is a potential complication of injecting long-acting steroids, such as triamcinolone (Kenalog), into the inferior turbinate, as reported in several studies 2, 3, 4, 5
- The mechanism of this complication is thought to be related to the injection of the steroid into a blood vessel, which can then travel to the retinal circulation and cause visual loss 4
- Other potential complications of inferior turbinate injections include orbital apex syndrome, which can result in symptoms such as ptosis, monocular blindness, ophthalmoplegia, and corneal anesthesia 6
- The risk of visual complications from intranasal steroid injections is estimated to be very low, around 0.003% 5
- Most cases of visual complications from intranasal steroid injections have been reported to resolve spontaneously with no permanent visual deficits 5
- Proper injection technique and precautions can help minimize the risk of complications from inferior turbinate injections 2, 4, 5