Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature

Abstract

Background Sudden loss of vision secondary to filler treatments is a rare but catastrophic complication. Objectives The aim of this study was to update the published cases of blindness after filler injection that have occurred since we published our review of 98 cases in 2015, and to discuss prevention and management strategies. Methods A literature review was performed to identify all cases of visual complications caused by filler injection identified between January 2015 and September 2018. Results Forty-eight new published cases of partial or complete vision loss after filler injection were identified. The sites that were highest risk were the nasal region (56.3%), glabella (27.1%), forehead (18.8%), and nasolabial fold (14.6%). Hyaluronic acid filler was the cause of this complication in 81.3% of cases. Vision loss, pain, ophthalmoplegia, and ptosis were the most common reported symptoms. Skin changes were seen in 43.8% of cases and central nervous system complications were seen in 18.8% of cases. Ten cases (20.8%) experienced complete recovery of vision, whereas 8 cases (16.7%) reported only partial recovery. Management strategies varied greatly and there were no treatments that were shown to be consistently successful. Conclusions Although the risk of blindness from fillers is rare, practitioners who inject filler should have a thorough knowledge of this complication including prevention and management strategies. Level of Evidence: 5

Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy

“…The ophthalmic artery gives off a branch called the central retinal artery, which travels through the optic nerve and its branches supply the retina. High‐risk areas include the glabella (supratrochlear and supraorbital arteries), nasal region (lateral and dorsal nasal arteries), nasolabial fold (angular artery), forehead (supratrochlear and supraorbital arteries) and temple area (superficial temporal artery) . In this case series, vision loss occurred when HA was used at nasal area in four out of six patients, and at forehead and temple area in the other two patients.…”

“…Early diagnosis of visual compromise from HA injection can be made by recognizing the signs and symptoms of sudden onset of severe pain accompanied by complete or partial loss of vision, blurred vision, visual field defect, nausea, vomiting, and headache. Nevertheless, central retinal artery occlusion may present without ocular pain and it is necessary to be cognizant of other red flag ocular signs which have been described, including ptosis, ophthalmoplegia, exotropia, and pupillary defect …”

“…The golden period to reverse retinal artery occlusion is 90 minutes . The patient should be transferred to the specialist as soon as possible.…”

Consensus statement on prevention and management of adverse effects following rejuvenation procedures with hyaluronic acid‐based fillers

“…It can occur if injection into an artery causes retrograde flow proximal to the central retinal artery's branching point, with the filler then being carried forward with the blood flow, eventually causing obstruction . Thus, irreversible vision loss should be added to the list of potential complications associated with injection of cosmetic facial fillers, regardless of where the filler is injected in the face …”

The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): A consensus on practical guidance

“…Blindness following soft tissue augmentation is a serious complication caused by occlusion of the branches of the ophthalmic artery to the eye . In 2015, a review of the world literature on all reported cases of vision changes from fillers was conducted to highlight key aspects of the vascular anatomy, as well as discuss prevention and management strategies . The results showed that 98 cases of vision changes from filler had been identified globally, with 65 of those leading to unilateral vision loss and only two cases being reversible.…”