Objectives: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols.

Introduction: A systematic literature review spanning 2018–2024 was conducted, analyzing case reports and studies on filler-related blindness, including seminal works by Lazzeri et al. (2012) and Kim EG et al. (2014). Data from a 2024 Aesthetic Surgery Journal review, identifying hyaluronic acid in 76% of cases, informed the focus on high-risk zones (nose, forehead, glabella) and treatment efficacy. Techniques such as hyaluronidase administration and intra-arterial interventions were assessed using clinical outcomes from peer-reviewed sources and ISAC Group World Guidance.

Materials / method: Management hinges on rapid recognition (within a 10-15-minute reperfusion window) and hyaluronidase administration, with the supraorbital method— championed by Dr. Treacy since 2013—preferred over retrobulbar injections (effective in only 5.3% of cases). A 2022 case by Nguyen et al. demonstrated vision recovery from no light perception to 20/50 using intra-arterial hyaluronidase and thrombolysis, highlighting advanced rescue potential.

Results: Blindness from dermal fillers arises from vascular occlusion, typically via retrograde embolization into the ophthalmic artery, leading to retinal artery occlusion (RAO). High-risk zones—nose (40.6%), forehead (27.7%), and glabella (19.0%)—correlate with arterial pathways like the supratrochlear and supraorbital arteries. Preventive measures include anatomical training, cannula use, and slow-injection protocols. Treatment efficacy hinges on rapid intervention within a 10-15-minute reperfusion window. The supraorbital hyaluronidase method, now favoured after being championed by early advocates,

Conclusion: Dermal filler-induced blindness, though an infrequent complication, remains a critical concern in aesthetic medicine due to its severe impact on patient quality of life. This analysis highlights that vascular occlusion, particularly in high-risk zones like the nose, forehead, and glabella, can be mitigated through rigorous anatomical training, refined injection techniques, and prompt emergency protocols. The shift toward cell-free interventions, such as hyaluronidase administration via the supraorbital approach and emerging intra-arterial therapies, offers hope for improved outcomes

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability