title: Retro or PeriBulbar Injection Techniques to Reverse Visual Loss After Filler Injections.
abstract: BACKGROUND
  With the increasing popularity of three dimensional filler treatments, the tip of the injecting needle or cannula is subdermal, often adjacent to the facial vasculature. Inadvertent canalization of these vessels can rarely result in vascular occlusion with consequent blindness or stroke.
  
  
  OBJECTIVE
  The goal was to demonstrate a technique of retro or peribulbar injection of hyaluronidase should such an emergency arise if no ophthalmologist was immediately available. The treatment is needed urgently because the retina can only withstand up to 90 minutes of hypoxia.
  
  
  METHODS
  We present verbal and diagrammatic instructions for this treatment and videos of both the retrobulbar technique (courtesy of Dr. D. Maberley) and peribulbar technique (courtesy of Dr. S. Fagien).
  
  
  RESULTS
  None of us have yet used this technique to treat iatrogenic filler induced blindness but we present the information for the benefit of patient safety, given the limited time the retina can survive vascular occlusion.
  
  
  CONCLUSIONS
  Inadvertent canalization of facial vessels can cause embolic occlusion of retinal vasculature because of the anastomotic nature of the facial vasculature and the end artery morphology of the retinal circulation. Embolism from 3-dimensional hyaluronic acid filler use is potentially reversible if hyaluronidase is injected into the adjacent tissue.
authors.affiliation: *University of British Columbia, Department of Ophthalmology, Vancouver, Vancouver, British Columbia, Canada †Private Practice, Oculoplastic Surgery, Boca Raton, Florida.
authors.forename: Jean
authors.initials: J
authors.lastname: Carruthers
authors.forename: Steven
authors.initials: S
authors.lastname: Fagien
authors.forename: Peter
authors.initials: P
authors.lastname: Dolman
mesh_terms: D000328:Adult; D001766:Blindness / Q000139:chemically induced* / Q000503:physiopathology; D003357:Cosmetic Techniques / Q000009:adverse effects*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D007267:Injections; D009915:Orbit; D020127:Recovery of Function; D055675:Viscosupplements / Q000008:administration & dosage / Q000009:adverse effects; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid