Vision Loss Following Nonsurgical Rhinoplasty Injections: Systematic Review of Cases and Management

Overview

Filler injected into the nose can enter an artery and travel backward to the eye. The authors searched Scopus, Ovid Medline and CINAHL, screened 1,498 unique articles, and extracted data from 21 articles reporting 22 cases of visual impairment after non-surgical rhinoplasty, summarising demographics, sites, filler types, treatment and outcomes.

Sections of note

• 22 cases; mean age 33.4; 90.9% female.
• Hyaluronic acid was the filler in 50% of cases.
• Vision loss occurred immediately in 82%.
• Injection site reported in 18 patients: nasal bridge or dorsum 57%, glabella 29%; 24% had multiple sites.
• Full recovery in 27% (mean 5.3 months); hyaluronidase, steroids and antibiotics usually failed to restore vision; hyperbaric oxygen "showed promise."

What it means for a patient

• Blindness after nasal filler is rare but usually permanent; three of four affected patients did not fully recover.
• The bridge and the area between the brows are the highest-risk zones because their arteries connect to the eye.
• Reversal agents often do not work once vision is lost; prevention by technique and anatomy is what matters.

Why this paper matters

It is the current systematic tally of the worst complication of a very common procedure. Limits: case reports only, under-reporting likely, no denominator to calculate incidence.

Terms

• Non-surgical rhinoplasty: reshaping the nose with injectable filler.
• Retrograde embolisation: filler pushed backward along an artery into the eye's blood supply.
• Hyaluronidase: an enzyme that dissolves hyaluronic acid filler.
• Glabella: the area between the eyebrows.
• Hyperbaric oxygen: breathing pure oxygen under pressure to help oxygen-starved tissue.