Management of Visual Loss Following Hyaluronic Acid Filler Injections: An Algorithm-based Approach

Hyaluronic acid (HA) filler injections have been associated with the rare but vision-threatening complication of retinal artery embolism. Clinical management of this condition remains challenging due to the lack of high-level evidence. Randomized controlled trials are neither ethically justifiable nor practically feasible, and current treatment recommendations are derived almost exclusively from individual case reports and small case series.

The aim of this article is to offer evidence-informed recommendations for the management of central retinal artery occlusion following HA filler injections. These recommendations are intended for both aesthetic practitioners and in-hospital specialists and are structured as stepwise treatment algorithms, based on published reviews and expert opinions as well as the clinical experience of the authors.

Algorithms are provided and organized into 2 sequential tiers: outpatient management and in-hospital management.

These guidelines are not intended to be complete or exhaustive but may prove informative for aesthetic physicians and in-hospital specialists who are responsible for treating patients with HA filler-induced central retinal artery occlusion. They should be regarded as a basis for treatment and discussion by clinicians, providing clear guidance under conditions of uncertainty.