Orbital Hemorrhagic Necrosis, Globe Rupture, and Death From Intraorbital Injection of 1% Sodium Deoxycholate in a Murine Model.

PURPOSE: Deoxycholic acid (DCA) 1% is an injectable detergent indicated for submental fat reduction, although clinically it is being injected off-label for orbital fat prolapse. It is known to cause severe inflammation, local nerve dysfunction, and tissue necrosis, all of which could be catastrophic in the orbit and periocular region. This study evaluated the effects of periocular DCA on orbital and ocular adnexal tissues in a murine model. METHODS: Mice were treated via split-face intraorbital injections, subcutaneous injections, and topical cornea application with DCA versus phosphate-buffered saline. Whole heads were fixed, decalcified, and sectioned for orbital histology after 1-7 days. Matched pairs of human globes and mouse globes were immersed in either phosphate-buffered saline or 1% DCA for 72 hours. RESULTS: Six of 11 mice receiving intraorbital DCA injections died within minutes. Surviving mice developed severe orbital inflammatory necrosis. All orbits injected with phosphate-buffered saline were clinically and histologically normal. Six mice were treated with lower concentrations of DCA and all developed variable amounts of orbital inflammation, hemorrhage, and globe necrosis. Mice receiving subcutaneous DCA injection to the lower eyelid showed inflammatory necrosis, edema, and lid malposition. Topical application of DCA to mouse corneas caused no external or histologic changes. Human and mouse globes immersed ex vivo in DCA developed corneal edema and cataract formation without observable scleral changes. CONCLUSION: Intraorbital and periocular injection of DCA can cause devastating complications in a murine model, and significant caution is advised for off-label use in the periocular region.

Relative selenium insufficiency is a risk factor for developing severe Graves' orbitopathy: a case-control study.

BACKGROUND/AIMS: Selenium (Se), an antioxidant agent, is effective in preventing mild Graves' orbitopathy (GO) deterioration. However, the significant risk of low serum Se concentration for GO progression has not been identified. Here, we aimed to investigate the risk of relative Se insufficiency and to identify its optimal cut-off value in the development of disease severity in patients with GO. METHODS: Serum Se levels were prospectively measured in 100 consecutive patients with GO. The patients were classified into groups with mild and severe GO (logistic regression analysis outcome). A receiver operating characteristic (ROC) curve and the minimum p value corresponding to χ2 statistics were analysed to select the optimal cut-off Se level for the diagnosis of severe orbitopathy. RESULTS: Thirty-two patients (32%) had mild GO and 68 (68%) had severe GO. The ROC revealed a cut-off Se level of 93 µg/L. Se levels ≤93 µg/L were observed in 48.5% and 12.5% of the patients in the severe and mild (p<0.001) groups, respectively. The risk estimate (OR) for an Se level ≤93 µg/L was 8.14 (95% CI 2.39 to 27.75). It remained a significant risk factor after adjusting for age, sex, thyroid status, smoking status, thyroidectomy and radioactive iodine. CONCLUSION: Relative Se insufficiency (≤93 µg/L) is a potential risk factor for severe GO development. An evaluation of Se status is recommended in patients with GO for predicting disease progression and guiding supplementation therapy.