Hatan Mortada1, Hadeel Seraj2, Omar Barasain3, Basma Bamakhrama4, Nawaf Ibrahim Alhindi5, Khalid Arab6. 1. Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University and Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia. hatanmortada@gmail.com. 2. Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 3. College of Medicine, King Saud University, Riyadh, Saudi Arabia. 4. Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. 5. Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia. 6. Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Abstract
BACKGROUND: With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications. METHODS: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome. RESULTS: A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management. CONCLUSION: HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
BACKGROUND: With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications. METHODS: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome. RESULTS: A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management. CONCLUSION: HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.