title: Cosmetic facial fillers and severe vision loss.
abstract: OBJECTIVE
  Dermal injection of cosmetic fillers can lead to irreversible blindness when injected in the forehead, and this possible adverse effect is not typically mentioned to patients.
  
  
  METHODS
  Vision loss from central retinal artery occlusion occurring, after cosmetic facial enhancement, was irreversible in 3 patients. However, 1 patient had a small amount of recovery with aggressive therapy.
  
  
  CONCLUSIONS
  Cosmetic facial fillers are not approved for use in the forehead, but off-label use for enhancement in this region is common. To our knowledge, there have been no prior reports of blindness caused by filler injected into the forehead. We present findings of central retinal artery occlusion due to fillers in 3 patients shortly after their cosmetic procedures. The filler presumably enters the central retinal artery via the rich external-internal carotid anastomoses and becomes embedded in the retinal tissues, potentially leading to irreversible and severe vision loss. Physicians performing cosmetic enhancement procedures involving facial fillers need to be aware of this potential complication and should include significant vision loss as a possible rare complication.
authors.forename: Michelle V
authors.initials: MV
authors.lastname: Carle
authors.forename: Richard
authors.initials: R
authors.lastname: Roe
authors.forename: Roger
authors.initials: R
authors.lastname: Novack
authors.forename: David S
authors.initials: DS
authors.lastname: Boyer
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D001766:Blindness / Q000139:chemically induced* / Q000175:diagnosis; D003094:Collagen / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005451:Fluorescein Angiography; D005546:Forehead; D005654:Fundus Oculi; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000008:administration & dosage / Q000009:adverse effects*; D012060:Rejuvenation; D055675:Viscosupplements / Q000008:administration & dosage / Q000009:adverse effects; D014792:Visual Acuity
chemical_list: C516180:ArteFill; D001672:Biocompatible Materials; D055675:Viscosupplements; D006820:Hyaluronic Acid; D003094:Collagen; D019904:Polymethyl Methacrylate