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

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