Soft-tissue augmentation carries potential for vision-threatening events
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WAILEA, Hawaii — Adverse reactions from soft tissue augmentation are usually mild, but oculoplastic specialists should be aware of potentially vision-threatening vascular compromise, according to a speaker at Hawaiian Eye 2021.
“Several of my friends have had patients who have lost vision permanently as a result of dermal filler injections, so it really does happen, and it is something that I think this community needs to be very much aware of,” Steve Yoelin, MD, said.
Vascular compromise is a possibility with all soft-tissue fillers, Yoelin said, with intravascular damage resulting from direct injection of the filler into the vasculature, causing obstruction and damage to the blood vessel walls.
“So what is happening if a patient complains of loss of vision, and it happens typically very quickly, within seconds of the incident,” Yoelin said. “The thing is, how much time do you have? One really doesn’t know. I don’t think you have 90 minutes, I don’t think you have an hour, I don’t think you even have a half hour. I think you have about 10 minutes to do something; otherwise, that eye is lost.”
Typically, and not as immediate, the first indication of extravascular damage after filler injection is painless blanching, which may be subtle and which may progress to painful, violaceous, reticulated patching, ulceration and scarring. To prevent permanent damage, Yoelin recommends patients seek treatment at the first sign of compromise.
Other early adverse events presenting within 1 week after injection are injection site reactions such as bruising, swelling and erythema, infections, nodules or asymmetry, and hypersensitivity, Yoelin said. Delayed reactions include infection, granuloma formation and biofilm formation.
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Yoelin S. Complications of dermal fillers. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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