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Study classifies blindness in patients with hyaluronic acid filler injections

After investigating nine patients who experienced vision loss after hyaluronic acid filler injections, researchers classified blindness into four distinct types.

They suggested that although hyaluronic acid filler injections are generally well-tolerated, blindness is possible. In addition to classifying vision loss, they aimed to predict disease course and prognosis by focusing on orbital symptoms of vision loss.

Eligible participants had received direct injection needle with doses ranging from 0.1 cc to more than 1 cc. Five patients had received injections in the glabella, three in the nasolabial fold, and three in the dorsum.

Results showed that during 6 months of follow-up evaluation, ptosis, ophthalmoplegia, and enophthalmos occurred. This prompted the researchers to classify patients into four categories of periocular symptom manifestation.

Two patients experienced blindness without ptosis or ophthalmoplegia, which the researchers determined to be type I. Type II comprised two patients with blindness and ptosis without ophthalmoplegia. Type III included two patients with blindness and ophthalmoplegia without ptosis, while type IV included three patients with blindness, ptosis and ophthalmoplegia.

Further analysis revealed no enophthalmos in the type I group, but that an average enophthalmos of 1 mm did occur in type II and III patients with ptosis or ophthalmoplegia with vision loss. An average enophthalmos of 1.7 mm displacement occurred in the three type IV patients.

The progression of enophthalmos demonstrated gradual change depending on the severity of periorbital symptoms, but did not correlate with improved visual acuity, according to the findings.

“It is likely that the majority of retinal and ophthalmic artery occlusions are initiated from vessels located near the glabella,” the researchers concluded. “A more accurate understanding of symptom progression will be possible with the analysis of additional cases, and additional anatomical evidence should also be studied in the future.” – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.