Severe Visual Loss and Orbital Infarction Following Periorbital Aesthetic Poly-(L)-Lactic Acid (PLLA) Injection

Abstract

Visual loss following esthetic treatment of the face is a rare but devastating iatrogenic complication. The authors report a case of a 43-year-old man with blindness and ophthalmoplegia of the left eye following a treatment of the left periorbital region with the subcutaneous filler poly-(L)-lactic acid. The patient's symptoms began immediately following one of the tunneled injections. On presentation, the patient had clear signs of ocular and orbital ischemia. Angiography and further history suggested an embolic orbital infarction as the mechanism of injury. The increased usage of subcutaneous fillers for facial rejuvenation had introduced a small but proven risk of embolization of these viscous materials to the eye and orbit.

Upper Eyelid Augmentation using Hyaluronic Acid Filler

“…Our study differs from the previous reported ones utilizing HA for upper eyelid augmentation in that by using a blunt cannula instead of sharp needle minimizes, if not eliminate, the inherent risk of sharp needle as has been reported including intravascular injections, nerve injuries [12][13][14][15][16][17] .…”

“…Different ways have been used to restore the volume, autologous fat transplantation and it is one of the methods that has some disadvantages, first the tissue being harvested from donor site, second the procedure may need sedation/ general anesthesia; third, the fat survival rate is variable and its volume may increase with weight gain [11] ; fourth, the formation of visible lumps which may need surgical excision and fifth. Embolization with vision loss or cerebrovascular accidents has been reported [12][13][14][15][16][17] . Hyaluronic acids have been used successfully in the periorbital rim with easy application, minimal down time in addition to the safe nature of the product and short duration of the procedure.…”

Blood Aspiration Test for Cosmetic Fillers to Prevent Accidental Intravascular Injection in the Face

“…20 The most catastrophic complications include blindness and brain injury. 21 Iatrogenic retinal artery obstruction may occur when pressure is applied to the plunger of a syringe and the needle is embedded in the arterial lumen, forcing a bolus of the syringe contents into the artery. When pressure on the plunger is released, the injected material may be forced by systolic blood pressure into the distal circulation, toward an anastomosis, and by retrograde reflux from the glabellar, zygomatic, infraorbital, temporal, or nasal dorsal area.…”

Exploring the Possibility of a Retrograde Embolism Pathway from the Facial Artery to the Ophthalmic Artery System In Vivo

“…Generally, the management of these complications is not difficult for physicians. However, devastating accidents, such as blindness [5][6][7][8][9][10], are still of concern. As early as 1906, there were reports that blindness occurred as a result of facial injections [18].…”

“…However, the procedure may also result in a series of complications, such as blindness due to intra-arterial filler emboli, which both patients and doctors consider a devastating event [5][6][7][8][9][10].…”