Ophthalmic complications of injectable facial fillers

The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery. One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit, causing unexpected effects at a site distant from that of the initial injection, including ophthalmoplegia, ptosis and even visual compromise. Acute vision loss following filler injection is a devastating complication, occurring in up to 0.0008% of cases. The greatest risk of this complication occurs with nasal augmentation, followed by glabellar wrinkle treatment. While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery, hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally. Treatment interventions include thrombolysis, hyperbaric oxygen therapy, oral aspirin, cobamamide and acetazolamide and administration of corticosteroids. However, most studies show a poor prognosis in the form of partial or no recovery of vision. Hence, prevention is of paramount importance. A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.