Phthisical eye and orbital ischemia after cosmetic platelet-rich plasma injection to the forehead

Management of visual complications of dermal filler injections

“…The supratrochlear and supraorbital arteries can inadvertently be infiltrated when injecting filler into the glabellar region, while the dorsal nasal artery is more likely to be accessed at the nasolabial fold. When the filler material is injected into one of these distal arteries, the relatively higher pressure of the injection compared to arterial pressure causes the filler to travel proximally towards the internal carotid, where it can embolize to the ophthalmic artery [7,8] . Ischemia occurs due to primary obstruction of blood flow by the embolus itself and secondary triggering of local inflammation, platelet aggregation, and activation of the coagulation cascade.…”

“…The ischemic consequences of filler-induced embolism can differ depending on the anatomic location affected. If the filler embolus lodges in the central retinal and posterior ciliary arteries, occlusion causes non-perfusion of the retina, manifesting as vision loss that can become permanent once irreversible retinal cell death occurs [8] . Occlusion of the posterior ciliary arteries and anterior ciliary arteries can limit blood flow to the iris and ciliary body, causing anterior segment ischemia, as well [10] .…”

“…In terms of intra-arterial thrombolysis in the setting of filler-induced vision loss, a paper by Zhang et al examined the utility of IAT with urokinase in combination with hyaluronidase specifically in patients who experienced vision loss after hyaluronic acid filler embolism [8] . In this paper, 10 out of 24 patients treated with either hyaluronidase or combined hyaluronidase and urokinase experienced improvement in visual acuity.…”

“…To target the initial inflammatory response and edematous sequelae of retinal ischemia, high-dose systemic glucocorticoids, such as IV methylprednisolone, can be administered to help manage the consequences of CRAO induced by filler embolism [8] . Finally, in some cases, hyperbaric oxygen therapy has been utilized to enhance oxygen delivery to areas of ischemia within the retina until hypoperfusion resolves [34] .…”