title: Ocular Pain and Impending Blindness During Facial Cosmetic Injections: Is Your Office Prepared?
abstract: Soft tissue filler injections are the second most common non-surgical procedure performed by the plastic surgeon. Embolization of intravascular material after facial injection is a rare but terrifying outcome due to the high likelihood of long-term sequela such as blindness and cerebrovascular accident. The literature is replete with examples of permanent blindness caused by injection with autologous fat, soft tissue fillers such as hyaluronic acid, PLLA, calcium hydroxyl-apatite, and even corticosteroid suspensions. However, missing from the discussion is an effective treatment algorithm that can be quickly and safely followed by injecting physicians in the case of an intravascular injection with impending blindness. In this report, we present the case of a 64-year-old woman who suffered from blindness and hemiparesis after facial cosmetic injections performed by a family physician. We use this case to create awareness that this complication has become more common as the number of injectors and patients seeking these treatments have increased exponentially over the past few years. We share in this study our experience with the incorporation of a "blindness safety kit" in each of our offices to promptly initiate treatment in someone with embolization and impending blindness. The kit contains a step-by-step protocol to follow in the event of arterial embolization of filler material associated with ocular pain and impending loss of vision.
  
  
  METHODS
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authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
authors.forename: Giselle
authors.initials: G
authors.lastname: Prado
authors.affiliation: Division of Plastic Surgery, Voluntary Clinical Faculty, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA. jrfeliz@miamiplasticsurgery.com.|Private Practice, Miami Plastic Surgery, 8940 N. Kendall Drive 903-E, Miami, FL, 33176, USA. jrfeliz@miamiplasticsurgery.com.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodríguez-Feliz
mesh_terms: D001766:Blindness / Q000139:chemically induced* / Q000503:physiopathology; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D058447:Eye Pain / Q000139:chemically induced* / Q000503:physiopathology; D005145:Face; D005158:Facial Paralysis / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D008875:Middle Aged; D018570:Risk Assessment; D015595:Skin Aging / Q000187:drug effects; D014786:Vision Disorders / Q000139:chemically induced / Q000503:physiopathology
chemical_list: D000067548:Dermal Fillers; D006820:Hyaluronic Acid
keywords: Blindness; Dermal fillers; Embolization; Facial injection