Retinal branch artery occlusion following injection of hyaluronic acid (Restylane)

Abstract

The authors report a retinal branch artery occlusion occurring after facial injection of a dermal filler. The superior temporal artery showed occlusion due to a clearly visible long and fragmented embolus suggestive of gel and clearly distinguishable from calcific or cholesterol emboli. The authors suppose that hyaluronic acid gel was embolized in the patient. The embolized material is supposed to enter the ocular circulation through retrograde arteriolar flow after intra-arterial injection into one of the peripheral branches of the ophthalmic artery. If there is any evidence of a visual problem after facial injection of a dermal filler, prompt consultation of an ophthalmologist is recommended.

Cosmetic Facial Fillers and Severe Vision Loss

“…1,2 Hyaluronic acid-based filler has also been reported to enter the ophthalmic circulation via the external carotid circulation after high-pressure injection. 3 Injected emboli have been reported to enter the ophthalmic circulation from the nasolabial folds 4 ; from glabellar, 2 intranasal, 1 and periocular 5 sites; and now, with our series, from the forehead. Any substance injected at high pressure into the oculofacial area, including the forehead, can result in occlusion of the central or branch retinal artery or the posterior ciliary circulation, both of which branch from the ophthalmic artery.…”

Ophthalmoplegia as a complication of cosmetic facial filler injection

“…In our patients, the hyaluronic acid appeared to have flowed retrograde into the ophthalmic artery via its distal branches supplying the superficial face, which acted as a conduit for the retrograde migration of the filler particles during high-pressure injections (Coleman 2002;Peter & Mennel 2006;Park et al 2012). Subsequently, the ophthalmic artery or its branches including the central retinal artery appeared to be occluded, resulting in blindness and ophthalmoplegia.…”

“…nterest in rejuvenation has increased the number of aesthetic soft tissue augmentation of the face using the filler injections (Park et al 2014). However, complications of filler injection include blindness, ophthalmoplegia or strokes (Coleman 2002;Peter & Mennel 2006;Park et al 2012). Herein we describe the patterns and prognosis of ophthalmoplegia as a complication of cosmetic facial filler in four patients.…”

Therapeutic Intra-arterial Hyaluronidase Infusion for Ophthalmic Artery Occlusion Following Cosmetic Facial Filler (Hyaluronic Acid) Injection

“…Although it is believed to be a simple and safe procedure, there are many reports [1][2][3][4] of severe complications, including skin necrosis and unilateral vision loss. This visual loss is caused by ischaemic retinal damage resulting from occlusion of the central retinal artery and ophthalmic artery by filler emboli and, thus far, we are unaware of any established therapeutic options.…”