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Vision Loss Following Non-surgical Rhinoplasty Injections: A Review Of Cases And Management Strategies
Manav M. Patel, Bachelor of Science and Arts in Biochemistry, Evan Pistone, Bachelor of Business and Arts in Finance, Long Nguyen, Bachelor of Science and Arts, Jeffrey M. Smith, MD.
The University of Texas Medical Branch, Galveston, TX, USA.
PURPOSE:This systematic review investigates vision loss following non-surgical rhinoplasty with dermal filler injections to provide insights into injury mechanisms, risk factors, and management strategies.
METHODS:A systematic search was conducted in Scopus, Ovid Medline, and CINAHL databases, resulting in 1498 unique articles. After screening, 21 articles (22 cases) met criteria.
RESULTS: 90.9% of patients were female, with an average age of 33.4 years (Table 1). Hyaluronic acid filler was used in 50% of cases. Vision loss was immediate in 18 cases, with only 27% cases achieving full recovery, averaging 5.3 months to restoration. Most cases (54%) involved injections into the nasal dorsum or bridge, areas linked with the highest rates of permanent blindness.
Table 1: Articles included
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Citation | Year of Publication | Country | Age | M/F | Final f/u time | Filler type | Place of injection | Time from injection to vision change | Length of vision change | Recovery of vision? | Extent of recovery | Prognosis |
Cohen et al, 2016 | 2016 | Israel | 24 | F | 18 mo | Calcium hydroxylapatite filler | Nasal bridge | Immediately | 18 mo | N | Permanent. Progressive nature of vision loss | Poor |
Eldweik et al, 2021 | 2021 | United Arab Emirates | 32 | F | 8 w | Hyaluronic acid | Nasal bridge | Immediately | Permanent | N | Blindness | Poor |
Sheptulin et al, 2022 | 2022 | Russia | 40 | F | 3 mo | Hyaluronic acid | Nasal dorsum | Immediately | 3 mo | Y | Vision impairment | Intermediate |
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Sung et al, 2010 | 2010 | South Korea | 25 | M | 3 mo | Calcium hydroxylapatite (CaHA,Radiesse, Bioform Inc., San Mateo, CA, U.S.A.) | N.R. - nose augmentation | 8 hrs | 3 mo | Y | Full restoration (affected eye had fixed dialated pupil) | Intermediate |
Sung et al, 2018 | 2018 | Taiwan | 24 | F | 2 mo | Calcium hydroxylapatite filler | Nasal bridge | 1 hr | 2 mo | Y | Full restoration | Good |
Xing et al, 2012 | 2012 | Canada | 23 | F | N.R. | Autologous fat injection | L lateral aspect of nose | 90 min | N.R | N.R. | N.R. | N.R. |
Chesnut et al, 2018 | 2018 | USA | 39 | F | N.R. | Hyaluronic acid | Near the infraorbital neurovascular bundle, | Immediately | NR | Y | Full restoration | Good |
Jolly et al, 2019 | 2019 | UK | 29 | F | 3 mo | Dermal filler | Nasal bridge | Immediately | Permanent | N | Vision impairment | Poor |
Sung et al, 2018 | 2018 | Taiwan | 24 | F | 2 mo | Calcium hydroxylapatite filler | Nasal bridge | 1 hr | 2 months | Y | Full Restoration | Good |
Kim et al, 2014 | 2014 | South Korea | 23 | M | 3 mo | Hyaluronic acid | N.R. - nose augmentation | Immediately | Permanent | N | Vision impairment | Poor |
Silva et al., 2004 | 2004 | Brazil | 52 | F | 10 mo | Microspheres of polymethyl-methacrylate | Injection into the glabellar area | Immediately | Permanent | N | Blindness | Poor |
Kim et al., 2013 | 2013 | South Korea | 19 | F | 3 w | Periorbital fat graft | Injection in nasal dorsum | Immediately | Permanent | N | Blindness | Poor |
Kim et al., 2014 | 2013 | South Korea | N.R. | F | 6 mo | Hyaluronic acid | Injection in nasal dorsum | Immediately | Permanent | N | Vision impairment | Poor |
Kim et al., 2011 | 2011 | South Korea | 30 | F | 6 mo | Hyaluronic acid | Injection in the nasal tip and bridge | Immediately | Permanent | N | Blindness | Poor |
Hwang et al., 2008 | 2008 | South Korea | 65 | F | 12 mo | N.R. | Injected into glabellar, paranasal, and periocular areas | Immediately | Permanent | Y | Vision impairment | Intermediate |
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Lee et al., 2017 | 2017 | South Korea | 25 | F | 6 mo | N.R. | N.R. - nose augmentation | Immediately | 6 mo | Y | Full restoration | Good |
Wibowo et al., 2019 | 2019 | Indonesia | 40 | F | 3 mo | Hyaluronic acid | Injection in nasal dorsum | Immediately | 3 mo | Y | Full restoration | Good |
Lucaciu et al., 2022 | 2022 | Germany | 43 | F | 2 mo | Hyaluronic acid | L glabellar area | Immediately | Permanent | N | Blindness | Poor |
Lucaciu et al., 2022 | 2022 | Germany | 29 | F | N.R. | Hyaluronic acid | N.R. - nose augmentation | Immediately | Permanent | N | Vision impairment | Intermediate |
Sharudin et al., 2018 | 2018 | Malaysia | 31 | F | 3 mo | Hyaluronic acid | Glabella and nasal dorsum | Immediately | 3 mo | Y | Full restoration | Good |
Vu et al., 2018 | 2018 | USA | 51 | F | 3 mo | Calcium hydroxylapatite filler | Glabella and nasal dorsum | Immediately | 3 mo | Y | Full Restoration | Good |
Oh et al., 2014 | 2014 | South Korea | 33 | F | 2 yrs | Hyaluronic acid | Glabella and nasal ala | Immediately | Permanent | N | Vision impairment | Poor |
CONCLUSION:The vascular anatomy of the nasal area predisposes this area to embolic complications during dermal filler injections, resulting in vision loss. Treatment strategies, including antibiotics, steroids, and hyaluronidase showed limited success. However, hyperbaric oxygen therapy demonstrated potential benefits in two cases, warranting further investigation. This study underscores the need for injector awareness of this rare but devastating complication.
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