Background: Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury.
Methods: The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face.
Results: Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite.
Conclusions: Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, V.
Pisa and Florence, Italy
From the Plastic and Reconstructive Surgery and Ophthalmology Units, University Hospital of Pisa, and the Maxillofacial Surgery Unit, University of Florence.
Received for publication September 12, 2011; accepted October 5, 2011.
Disclosure: There are no financial conflicts or interests to report in association with the content of this article.
Davide Lazzeri, M.D.; Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Via Paradisa 2, Cisanello, 56100 Pisa, Italy, firstname.lastname@example.org