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Case Report: Bilateral vision-threatening anterior segment injury following periocular cosmetic high-intensity focused ultrasound

Year: 2026

Type: article

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/cm 2 ; 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.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1891995