From the Guidelines
The documented complication of inferior turbinate steroid injection is blindness (option a). This rare but serious complication occurs when steroid particles inadvertently enter the ophthalmic artery or its branches through retrograde flow. During injection, if excessive pressure is applied or if the needle inadvertently enters a blood vessel, the steroid suspension can travel through the vascular system to the eye. The particles can then embolize the retinal or ophthalmic arteries, causing immediate and often permanent vision loss. This complication highlights the importance of proper injection technique, including aspiration before injection, using low pressure during administration, and being familiar with the vascular anatomy of the nasal region. According to the study by 1, permanent vision loss because of cavernous vein thrombosis has been reported in 0.006% of patients. While other complications like atrophy, crusting, and recurrence can occur with turbinate procedures, blindness represents the most severe documented complication specific to steroid injection in this area.
Some key points to consider when evaluating the risks and benefits of inferior turbinate steroid injection include:
- The potential for serious complications, such as blindness, exists, although it is rare
- Proper injection technique is crucial to minimizing the risk of complications
- The benefits of steroid injection, including reduced nasal obstruction and improved symptoms, must be weighed against the potential risks
- Alternative treatments, such as oral corticosteroids or other medical therapies, may be considered in some cases
It is essential to carefully evaluate the individual patient's situation and medical history before proceeding with inferior turbinate steroid injection, and to discuss the potential risks and benefits with the patient. As noted in the study by 1, nasal and oral corticosteroids are safer alternatives, and the use of steroid injection should be carefully considered in light of these options.
From the Research
Documented Complications of Inferior Turbinate Steroid Injection
- The documented complication of inferior turbinate steroid injection is blindness, as reported in several studies 2, 3, 4, 5.
- This complication is rare, with an estimated visual complication rate of 0.003% 5.
- The blindness is usually caused by inadvertent intra-arterial injection of the steroid, leading to embolization of the retinal circulation 2, 3, 4.
- Other potential complications, such as stroke, recurrence, atrophy of the nose, and crusting, are not supported by the available evidence.
- The available evidence suggests that intranasal steroid injections are a safe treatment for chronic rhinitis and sinusitis patients when performed correctly 5, 6.