Vision-Threatening Complications of Soft Tissue Fillers: A Report by the American Academy of Ophthalmology.
Vision loss from filler injection usually does not improve despite treatment.
Vision-Threatening Complications of Soft Tissue Fillers: A Report by the American Academy of Ophthalmology.
To review evidence on ocular complications of injectable soft tissue fillers, identify features associated with risk for vision loss, and assess the efficacy and safety of reported treatments.
Literature search of the PubMed database was last conducted in May 2024.
All 19 articles were assigned a level III rating by the panel methodologist.
This assessment identified 198 cases of vision loss caused by accidental intravascular injection of filler material, hyaluronic acid gel in 164 cases (83%), autologous fat in 29 cases (15%), collagen in 3 cases, poly-L lactic acid gel in 1 case, and calcium hydroxyapatite in 1 case.
The 226 injection sites, sometimes multiple locations, when described, were nose in 90 cases (40%); forehead in 56 cases (25%); glabella in 26 cases (12%); temple in 21 cases (9%) frontal in 17 cases (7%); nasolabial fold in 9 cases (4%); face in 2 cases; periocular in 2 cases; and lip, eyebrow, cheek, and upper eyelid in 1 case each.
Inadvertent intravascular injection of soft tissue fillers is associated with cases of vision loss, with upper and central midface a common site of injection.
This suggests zones of higher risk for vision loss compared with other facial areas. Hyaluronic acid gel was the most common material, although vison loss was also associated with a variety of other filler materials.
No evidence-based protocol has been established for managing vision loss, but intra-arterial thrombolysis has had some success in recanalizing occluded arteries.