Light Perception Vision Recovery After Treatment for Calcium Hydroxylapatite Cosmetic Filler–Induced Blindness

Abstract

A 51-year-old woman presented with no light perception vision of the right eye 12 hours after another provider injected calcium hydroxylapatite into the glabella and dorsum of the nose. Exam and fluorescein angiography demonstrated optic nerve edema and choroidal hypoperfusion consistent with ischemia of the posterior ciliary circulation. The central retinal circulation appeared intact. One thousand two hundred units of retrobulbar hyaluronidase were injected urgently in several boluses. Oral prednisone and aspirin also were administered. Ocular massage was also initiated. One day later, visual acuity improved to light perception that remained stable at 3 months. Retrobulbar hyaluronidase injection, ocular massage, prednisone, and aspirin were correlated to recovery of light perception vision in this case of calcium hydroxylapatite filler embolization to the choroidal circulation. The mechanism for the recovery of some vision and the role of hyaluronidase and other medications remain uncertain. Further research in treatments for ophthalmic complications of facial fillers is warranted.

Complications of Nonpermanent Facial Fillers: A Systematic Review

“…Hyaluronidase injected locally after CaHa-induced ischemic complications was explained with some effect on the microcirculation and not directly as a result of its enzymatic degradation as observed after HA injections, but this is still uncertain and needs further research. 32 …”

The use of periocular fillers in aesthetic medicine

“…24,[60][61][62][63][64][65][66][67] HA was the most commonly used dermal filler, [61][62][63][64] followed by AF. [65][66][67] CaHA 60 and PLLA 24 were also used. One could argue that AF is disproportionately represented here, indicating its increased risk of sight loss over other dermal fillers.…”

“…65 The glabella area was the most commonly treated area associated with visual loss. [60][61][62]65,66 Ophthalmic artery occlusion was the most commonly documented vascular level of obstruction. 24,61,62,66,67 Hyaluronidase is used in cases of HA-induced obstruction.…”

“…24,61,62,66,67 Hyaluronidase is used in cases of HA-induced obstruction. [61][62][63][64] The methods of delivery and doses varied with intradermal, 61,64 periocular, 60 retrobulbar, 60 infraorbital 63 supraorbital 63,64 and supratrocheal 64 administration attempted.…”

“…[57][58][59] therapy or oral steroids [57][58][59] Visual Loss 9 cases reports in the literature. 24,[60][61][62][63][64][65][66][67] Hyaluronidase injection is used in cases of HAinduced obstruction. [61][62][63][64] Two case reports of complete restoration of vision.…”