Transient cortical blindness after intradiscal oxygen-ozone therapy
Vaiano AS, Valente C, De Benedetti G, Caramello G. Indian Journal of Ophthalmology, 2016.
- Study type
- Case report
- People studied
- 1 person
- Population
- 54-year-old Caucasian man with lumbar sciatica and migraine, given an L5-S1 intradiscal and periganglionic oxygen-ozone injection for disc herniation
- Published
- 2016, Indian Journal of Ophthalmology
- Identifiers
- PMID 28112142, DOI 10.4103/0301-4738.198858
What the authors reported
About one minute after an L5-S1 oxygen-ozone injection (4 ml intradiscal and 11 ml periganglionic; ozone 27 μg/mL) the patient lost vision in both eyes, followed by headache and vomiting. MRI showed ischemic lesions in both posterior cerebral artery territories, and transesophageal echocardiography a large patent foramen ovale. Vision recovered fully by day 9 and was normal at 2 months.
What limits this result
Single case report: it shows the event can follow this procedure, not how often it occurs. The authors consider air embolism through a patent foramen ovale the most likely cause but state that the pathophysiology remains elusive; the diagnosis rests on clinical findings and timing, and they also list an incidental stroke unrelated to the procedure as possible.
Harms reported after ozone therapy, and studies of how ozone exposure affects health. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Case report (published as a brief communication)
We herein describe a case of CB as a result of bilateral occipito-parietal lobe ischemia following OOT medical application.
- Setting
- Struttura Complessa di Oculistica, Azienda Ospedaliera Santa Croce e Carle di Cuneo, Cuneo, Italy (author affiliation)
- Read from
- Read from the full text of the paper. Read on October 2, 2026.
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | L5-S1 injection of an oxygen-ozone mixture, 4 ml intradiscal and 11 ml periganglionic, at an ozone concentration of 27 μg/mL; blindness began about 1 minute later |
Source: Full text on PubMed Central
Procedure as reported
- Ozone concentration
- 27 μg/mL
of an oxygen–ozone mixture (ozone concentration of 27 μg/mL)
In the paper's own units, not converted.
Source: Full text on PubMed Central
What it measured
- Symptoms after the onset of blindness
- Severe frontal headache, vomiting, and nausea after 5 minutes
- Bedside ophthalmic examination
- Bilateral blindness with no light perception but a positive pupillary light reflex
- CT scan within 2 hours of onset
- No signs of an acute ischemic lesion or hemorrhagic stroke
A computed tomography scan performed by 2 h after the onset of VL and headache symptoms showed no signs of an acute ischemic lesion or hemorrhagic stroke.
- Brain MRI
- Consistent with recent ischemic lesions in both posterior cerebral artery territories
Magnetic resonance data were consistent with recent ischemic lesions in bilateral vascular territories of posterior cerebral arteries.
- Transcranial Doppler with contrast saline
- Ten microembolic signals at baseline and during Valsalva release
Transcranial Doppler emboli detection with contrast saline showed the presence of ten microembolic signals (high-intensity transient signals) during baseline conditions and during Valsalva release.
- Transesophageal contrast echocardiography
- Large patent foramen ovale and atrial septal aneurysm, with early microbubbles in the left atrium during Valsalva release
- Visual acuity
- Began to improve on day 4; full recovery (20/20 in both eyes) on day 9
- Brain MRI after 4 months
- Hyperintensities reduced in size compared with the earlier sequences
Brain MRI performed after 4 months showed size reduction of the hyperintensities compared to the same sequences of the affected areas
Safety as reported
Transient cortical blindness from ischemia of both occipito-parietal lobes; the authors support air embolism as the most likely cause and state that the pathophysiology remains elusive
Source: Full text on PubMed Central
Follow-up
2 months; visual acuity 20/20 in both eyesDuring the follow-up, after 2 months, we observed VA of 20/20 in both eyes.
Source: Full text on PubMed Central
Funding and conflicts
No conflicts of interest declared
Source: Full text on PubMed Central
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