Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature

Ophthalmoplegia with skin necrosis after a hyaluronic acid filler injection

“…Although visual loss after iatrogenic ophthalmic artery occlusion has been well described in the previous report, few studies have discussed ophthalmoplegia without blindness. [1][2][3][4] Here, we report a 23-year-old woman with ptosis, diplopia, right eye lateral deviation, and skin necrosis after hyaluronic acid filler injection, who had a complete recovery.…”

Pinch anatomy: An injection guide for temple filler injections

“…Photograph showing the "gentle pinch" maneuver in the temple, with thumb and index finger F I G U R E 2 Diagram showing the bunching up of skin and subcutaneous fat with "gentle pinch" without including the superficial temporal fascia in the pinch, creating a space for injection in the layers of subcutaneous fat layer F I G U R E 3 Photograph showing the "deep pinch" or "pinch and pull" maneuver in the temple, with thumb and index finger F I G U R E 4 Diagram showing the bunching up of skin, subcutaneous fat, and superficial temporal fascia with "deep pinch" or "pinch and pull" maneuver, creating a significant space for injection in the avascular, loose areolar tissue layer While performing the filler injections, one should be cautious not to inject in the blood vessels to avoid significant complications in the form of skin necrosis, 6 vision loss, 7,8 and nonthrombotic pulmonary embolism. 9 Knowing the precise location and correct depth of major blood vessels, based on facial surface anatomy, is necessary for safe and effective filler injections.…”

Iatrogenic vision loss following aesthetic treatment with hyaluronic acid‐containing filler: Every injector should be prepared

“…As the initiation of treatment with Hyaluronidase within 90 min is an arbitrary time frame and recent systematic reviews on soft tissue filler related blindness has reported the time of onset of visual symptoms from immediate (in the majority of the cases) to 24 hours; it is of utmost importance to initiate peribulbar or retrobulbar hyaluronidase protocol at the earliest. 4,5 However, considering the varied specialties and expertise of the aesthetic practitioners, we wonder how safe would it be to perform RBH in a consultation room, or the practicality for patient transfer to tertiary care within 90 min as proposed by the author considering the variability, diversity and availability of such care across the globe. It is quite apparent that ischemic events are best managed at a tertiary care center, well equipped with a skilled interventionist, considering the possibility of cerebral infarction and hemiplegia that could also be associated with post filler blindness.…”