Enophthalmos after Carboxytherapy for Peri-Ocular Hyperpigmentation

Purpose: Carboxytherapy (injection of CO2 gas) is commonly used for its temporary effect on peri-ocular skin hyperpigmentation (POH) which has shown to be even more effective in lipolysis. Its reported side effects are pain, burning sensation, erythema, edema, and bruising. The aim is to firstly report a patient who developed enophthalmos after carboxytherapy for her POH. Methods: A 32-year-old woman was referred with chief complaint of gradual enophthalmos on the left eye after having carboxytherapy for her bilateral POH a year ago. Results: Hertel exophthalmometry showed a 3.5 mm enophthalmos and 2 mm hypo-ophthalmos on the left eye. Ocular, ocular motility, ocular adnexal, and systemic examinations were otherwise normal. Orbital and paranasal sinuses computed tomography (CT) scan was within normal limits. Her face photos from before and after the carboxytherapy (taken by the patient herself on her mobile phone) showed a gradual posterior and inferior displacement of the left globe. Penetration of injected CO2 into the orbital cavity and its lipolytic effect could be the reason for globe displacement based on clinical examination, before/ after photos, and imaging. Conclusion: This is the first report of enophthalmos/ hypo-ophthalmos after carboxytherapy for POH. This complication should be discussed on pre-injection counselling.