Blindness; The Worst Filler Complication

Blindness is by far one of the most terrifying filler complications any client or clinician could experience.

To develop the safest injection strategies, any practising clinician must learn in detail about this filler complication.

How high is the risk of blindness?

In 2015, 98 cases of blindness as a result of filler complications were reviewed.

It was apparent from this research that there is a range of variables that correlate with the risk of blindness.

The 5 variables that were discovered:

• The anatomy of the face and how it relates to the eye.
• The area injected.
• The type of product injected.
• The volume of product injected.
• The technique used to place the product.

Also, they analysed which region/muscle of the face most cases of blindness occurred in (see chart below for results)

It’s important to remember that these percentages are not necessarily related to the relative risk of injecting in each area.

It is not possible to tell from this subset of data whether or not the differences in percentages represent a difference in the vulnerability of the ocular blood supply in each area.

We should assume that there is a risk in all areas of the face.

The Different Routes Dermal Filler Can Take

Hypothetically speaking there are 15 different routes which dermal filler could take to cause blindness as a complication.

1. Direct injection into the supratrochlear artery and then in turn into the ophthalmic circulation.
2. Direct injection into the supraorbital artery and then into the ophthalmic circulation.
3. Direct injection into the dorsal nasal artery and then into the supratrochlear artery and in turn into the ophthalmic circulation.
4. Direct injection into the angular artery and then into the supratrochlear artery and on to the ophthalmic artery.
5. Injection into the palpebral arteries which branch from the supratrochlear and ophthalmic arteries.
6. Direct injection into the superficial temporal artery and then through anastomoses into the supratrochlear and supraorbital arteries and then into the ophthalmic circulation.
7. Direct injection into the Deep temporal artery and then through the maxillary artery and the accessory branch of the middle meningeal artery into the ophthalmic circulation.
8. Direct injection into the middle temporal vein and then through the veins that drain the eye into the Cavernous sinus.
9. Blockage of the ophthalmic vein superior and inferior through injections of the periorbital area.
10. Compression or blockage of the vorticose veins which drain the eye. The lateral veins are most vulnerable in rare circumstances.
11. Stroke causing damage to the optic tract or visual cortex.
12. The pressure of a haematoma onto the eye.
13. Blocked venous blood supply.
14. Blocked arterial blood supply.
15. Stroke or damage to the optic tract.

How To Diagnose Blindness

The symptoms of blindness as a filler complication will appear almost immediately, certainly within a few minutes of the procedure.

Blockage of the central retinal artery would stop the retina working within seconds.

Many people have experienced this during a drop in blood pressure when standing up too quickly.

The sense of your vision decreasing rapidly until you bend or sit down demonstrates how rapidly the retina stops functioning without blood flow.

In the example where dermal filler enters an artery and makes its way directly to the central retinal artery, the expected outcome would be blindness in seconds.

This is the most common and terrifying pattern scene in the literature.

Hours after the visual symptoms occur the effect on the muscles and the skin around the eye may occur.

At this stage patients develop ptosis or ophthalmoplegia and the injury becomes visually obvious to the clinician.

These signs and symptoms are important because they give a clue as to where the potential injury is and may aid further treatment.