Risk Management
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Periocular Repository Corticosteriod Injections
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NOTE: THIS FORM IS INTENDED AS A SAMPLE FORM. IT CONTAINS THE INFORMATION OMIC RECOMMENDS YOU AS THE SURGEON PERSONALLY DISCUSS WITH THE PATIENT. PLEASE REVIEW IT AND MODIFY TO FIT YOUR ACTUAL PRACTICE. GIVE THE PATIENT A COPY AND SEND THIS FORM TO THE HOSPITAL OR SURGERY CENTER AS VERIFICATION THAT YOU HAVE OBTAINED INFORMED CONSENT.
Version 12/2/2002
POTENTIAL COMPLICATIONS ASSOCIATED WITH PERIOCULAR REPOSITORY CORTICOSTEROID INJECTION(S)
- Inadvertent injection into the choroidal or retinal circulation, emboli.
- Perforation of the globe with permanent loss of vision/loss of eye.
- Cataract.
- Glaucoma (increased eye pressure) in injected/other eye that may be transient or permanent and could lead to medical or surgical treatment (i.e., excision of depot or glaucoma filtering operation).
- Blepharoptosis.
- Proptosis.
- Orbital fat atrophy, fibrosis.
- Delayed hypersensitivity reactions.
- Strabismus.
- Conjunctival hemorrhage.
- Chemosis.
- Infection.
- Pain from injection, syncope, adhesions, worsening of condition, Cushing’s Syndrome, pupillary dilatation.
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