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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

CitationYear of Publication CountryAgeM/FFinal f/u time Filler type Place of injection Time from injection to vision changeLength of vision change Recovery of vision?Extent of recovery Prognosis
Cohen et al, 20162016Israel24F18 moCalcium hydroxylapatite fillerNasal bridgeImmediately18 moNPermanent. Progressive nature of vision lossPoor
Eldweik et al, 20212021United Arab Emirates32F8 wHyaluronic acidNasal bridgeImmediatelyPermanentNBlindnessPoor
Sheptulin et al, 20222022Russia40F3 moHyaluronic acidNasal dorsumImmediately3 moYVision impairmentIntermediate

Sung et al, 20102010South Korea25M3 moCalcium hydroxylapatite (CaHA,Radiesse, Bioform Inc., San Mateo, CA, U.S.A.)N.R. - nose augmentation8 hrs3 moYFull restoration (affected eye had fixed dialated pupil)Intermediate
Sung et al, 20182018Taiwan24F2 moCalcium hydroxylapatite fillerNasal bridge1 hr2 moYFull restorationGood
Xing et al, 20122012Canada23FN.R.Autologous fat injectionL lateral aspect of nose90 minN.RN.R.N.R.N.R.
Chesnut et al, 20182018USA39FN.R.Hyaluronic acidNear the infraorbital neurovascular bundle,ImmediatelyNRYFull restorationGood
Jolly et al, 20192019UK29F3 moDermal fillerNasal bridgeImmediatelyPermanentNVision impairmentPoor
Sung et al, 20182018Taiwan24F2 moCalcium hydroxylapatite fillerNasal bridge1 hr2 monthsYFull RestorationGood
Kim et al, 20142014South Korea23M3 moHyaluronic acidN.R. - nose augmentationImmediatelyPermanentNVision impairmentPoor
Silva et al., 20042004Brazil52F10 moMicrospheres of polymethyl-methacrylateInjection into the glabellar areaImmediatelyPermanentNBlindnessPoor
Kim et al., 20132013South Korea19F3 wPeriorbital fat graftInjection in nasal dorsumImmediatelyPermanentNBlindnessPoor
Kim et al., 20142013South KoreaN.R.F6 moHyaluronic acidInjection in nasal dorsumImmediatelyPermanentNVision impairmentPoor
Kim et al., 20112011South Korea30F6 moHyaluronic acidInjection in the nasal tip and bridgeImmediatelyPermanentNBlindnessPoor
Hwang et al., 20082008South Korea65F12 moN.R.Injected into glabellar, paranasal, and periocular areasImmediatelyPermanentYVision impairmentIntermediate

Lee et al., 20172017South Korea25F6 moN.R.N.R. - nose augmentationImmediately6 moYFull restorationGood
Wibowo et al., 20192019Indonesia40F3 moHyaluronic acidInjection in nasal dorsumImmediately3 moYFull restorationGood
Lucaciu et al., 20222022Germany43F2 moHyaluronic acidL glabellar areaImmediatelyPermanentNBlindnessPoor
Lucaciu et al., 20222022Germany29FN.R.Hyaluronic acidN.R. - nose augmentationImmediatelyPermanentNVision impairmentIntermediate
Sharudin et al., 20182018Malaysia31F3 moHyaluronic acidGlabella and nasal dorsumImmediately3 moYFull restorationGood
Vu et al., 20182018USA51F3 moCalcium hydroxylapatite fillerGlabella and nasal dorsumImmediately3 moYFull RestorationGood
Oh et al., 20142014South Korea33F2 yrsHyaluronic acidGlabella and nasal alaImmediatelyPermanentNVision impairmentPoor

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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