Bilateral Blindness after Filler Injection

• DOI: 10.1097/prs.0b013e318278d6e1
• Publication Date: 2013-01-29T16:36:17Z
• Authors: Yong Joon Kim; Kyung Seek Choi
• Keywords: Ecchymosis

Sir:FigureThere are various complications, including hypersensitivity reaction, ecchymosis, contour abnormalities, inflammation, and necrosis, that occur after filler injection.1 Among other things, blindness is a rare but devastating complication of cosmetic injection the face. There several reports following injections materials, corticosteroids, paraffin, silicone oil, hyaluronic acid, calcium hydroxyapatite.2 However, to best our knowledge, bilateral has not been previously reported with injection. A healthy 30-year-old man who received hydroxyapatite for nose augmentation was presented in both eyes. Initial visual acuity eyes no light perception. Both pupils were fully dilated, reflex present. Inspection revealed blepharoptosis total ophthalmoplegia on sides, central skin along surrounding reddish reticular pattern affecting bridge frontal area. The patient had conjunctival multiple emboli vessels Retinal edema noticeable, visible located choroidal retinal arteries (Fig. 1). Fluorescein indocyanine green angiography disturbances circulations delayed vascular filling caused by emboli. Hyperreflective foci corresponding deposits detected optical coherence tomography. Computed tomography also showed linear nose. He diagnosed anterior segment ischemia, ophthalmoplegia, ophthalmic artery obstruction, injection.Fig. 1: Fundus photographs (white arrowheads) arrows).Vascular supply eyeball periorbital area derived from artery. Filler material, which injected into terminal branch artery, can enter ocular circulation high-pressure subsequently leads peripheral obstruction.3 Therefore, blindness, necrosis occur, bilaterally. This first case ischemia To avoid such some techniques, aspiration before low-pressure injection, should be kept mind diminish risk embolization.2–4 Yong Joon Kim, M.D. Kyung Seek Choi, Soonchunhyang University Hospital, Seoul, Korea DISCLOSURE authors have financial interest any products or devices mentioned this article.