Ocular Pain and Impending Blindness During Facial Cosmetic Injections: Is Your Office Prepared?

Aesthetic Plast Surg. 2017 Feb;41(1):199-203. doi: 10.1007/s00266-016-0728-4. Epub 2016 Dec 28.


Soft tissue filler injections are the second most common non-surgical procedure performed by the plastic surgeon. Embolization of intravascular material after facial injection is a rare but terrifying outcome due to the high likelihood of long-term sequela such as blindness and cerebrovascular accident. The literature is replete with examples of permanent blindness caused by injection with autologous fat, soft tissue fillers such as hyaluronic acid, PLLA, calcium hydroxyl-apatite, and even corticosteroid suspensions. However, missing from the discussion is an effective treatment algorithm that can be quickly and safely followed by injecting physicians in the case of an intravascular injection with impending blindness. In this report, we present the case of a 64-year-old woman who suffered from blindness and hemiparesis after facial cosmetic injections performed by a family physician. We use this case to create awareness that this complication has become more common as the number of injectors and patients seeking these treatments have increased exponentially over the past few years. We share in this study our experience with the incorporation of a "blindness safety kit" in each of our offices to promptly initiate treatment in someone with embolization and impending blindness. The kit contains a step-by-step protocol to follow in the event of arterial embolization of filler material associated with ocular pain and impending loss of vision.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Blindness; Dermal fillers; Embolization; Facial injection.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Blindness / chemically induced*
  • Blindness / physiopathology
  • Cosmetic Techniques / adverse effects*
  • Dermal Fillers / administration & dosage
  • Dermal Fillers / adverse effects*
  • Eye Pain / chemically induced*
  • Eye Pain / physiopathology
  • Face
  • Facial Paralysis / chemically induced*
  • Facial Paralysis / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / adverse effects*
  • Injections, Subcutaneous
  • Middle Aged
  • Risk Assessment
  • Skin Aging / drug effects
  • Vision Disorders / chemically induced
  • Vision Disorders / physiopathology


  • Dermal Fillers
  • Hyaluronic Acid