title: Prevention and management of vision loss relating to facial filler injections.
abstract: BACKGROUND
  With the increased use of filler and fat injections for aesthetic purposes, there has been a corresponding increase in the incidence of complications. Vision loss as an uncommon but devastating vascular side effect of filler injections was the focus of this paper.
  
  
  METHODS
  A review committee, consisting of plastic surgeons, aesthetic medical practitioners, ophthalmologists and dermatologists from Singapore, was convened by the Society of Aesthetic Medicine (Singapore) to review and recommend methods for the prevention and management of vision loss secondary to filler injections.
  
  
  RESULTS
  The committee agreed that prevention through proper understanding of facial anatomy and good injection techniques was of foremost importance. The committee acknowledged that there is currently no standard management for these cases. Based on existing knowledge, injectors may follow a proposed course of action, which can be divided into immediate, definitive and supportive. The goals were to reduce intraocular pressure, dislodge the embolus to a more peripheral location, remove or reverse central ischaemia, preserve residual retinal function, and prevent the deterioration of vision. Dissolving a hyaluronic acid embolus remains a controversial option. It is proposed that injectors must be trained to recognise symptoms, institute immediate actions and refer patients without delay to dedicated specialists for definitive and supportive management.
  
  
  CONCLUSIONS
  Steps to prevent and manage vision loss based on current evidence and best clinical practices are outlined in this paper. Empirical referral to any emergency department or untrained doctors may lead to inordinate delays and poor outcomes for the affected eye.
authors.affiliation: David Loh Surgery, Singapore.
authors.forename: Kwok Thye David
authors.initials: KT
authors.lastname: Loh
authors.affiliation: JJ Chua Rejuvenative Cosmetic & Laser Surgery, Singapore.
authors.forename: Jun Jin
authors.initials: JJ
authors.lastname: Chua
authors.affiliation: Lee Hung Ming Eye Centre, Gleneagles Hospital, Singapore.
authors.forename: Hung Ming
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Joyce Lim Skin and Laser Clinic, Singapore.
authors.forename: Joyce Teng-Ee
authors.initials: JT
authors.lastname: Lim
authors.affiliation: Total Eyecare Center, Singapore.
authors.forename: Gerard
authors.initials: G
authors.lastname: Chuah
authors.affiliation: Dr Benjamin Yim Clinical Aesthetics & Laser Centre, Singapore.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Yim
authors.affiliation: Amaris B Clinic, Singapore.
authors.forename: Boon Kwang
authors.initials: BK
authors.lastname: Puah
mesh_terms: D001766:Blindness / Q000209:etiology / Q000517:prevention & control*; D000067548:Dermal Fillers / Q000009:adverse effects*; D004617:Embolism; D004954:Esthetics; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D007049:Iatrogenic Disease; D015994:Incidence; D007267:Injections / Q000009:adverse effects*; D009885:Ophthalmology; D012846:Singapore; D012955:Societies, Medical
chemical_list: D000067548:Dermal Fillers; D006820:Hyaluronic Acid
keywords: aesthetic medicine; blindness; facial fillers; filler injection; hyaluronic acid