The authors endeavored to remove the embolism to a collateral branch of the artery by the use of amyl nitrate, digitalis, and pressure on the globe of the eye, with no effect. Some hours later edema of the retina appeared, followed by permanent loss of sight. The same authors have observed several cases of pulmonary embolism result from the injection of paraffin.
It is also a fact that injections of the nature being considered, while not causing immediate embolism, may do so as a result of phlebitis, caused by a direct injection into the vein or over or upon it in such a way as to cause irritation.
Mintz reports a third case of amaurosis following a paraffin injection. The latter was made to correct a saddle deformity caused by syphilis. Three minutes after the injection the patient complained of pain in the left eye, which was followed by total blindness, vomiting, and a pulse of 48. Several days later there appeared symptoms of venous congestion in the orbit, paralysis of the ocular muscles, corneal cloudiness, and exophthalmos, a small gangrenous spot appeared at the site of the injection.
Brœckært observed a case of facial phlebitis, followed by pulmonary infarction. Brindel cites a case in which he observed a hard line of considerable extent and painful to the touch, extending from the inner angle of the eye to the angle of the eye, where it deviated toward the root of the nose and terminated at the origin of the eyebrow.
De Cazeneuve made an injection, and on the following day noted that the right cheek had increased considerably in size with an elevation of temperature in the part. Two days after, under the right eye and to the right of the nose, the whole cheek was red, hot, and much distended, giving the skin a glazed appearance. Palpation was extremely painful. A hard line could be made out, extending from the inner angle of the eye outward and downward under the lower eyelid and terminating in the center of the edematous cheek. The phlebitis in this case resulted without the development of an embolism.
After a careful study of the causes of such embolisms we come to the conclusion:
1. That the injected mass should not be heated above a certain melting point.
2. That hyperinjection should at all times be avoided, particularly with paraffins of high melting points.
3. That the injection should be made subcutaneously not into parenchymatous tissues, and
4. That a puncture of a vein or the introduction of the injected mass into a vein should be avoided.