Hyaluronic acid induced blindness and orbital ischemic syndrome: a case report

The incidence of filler-induced blindness is unknown due to the few reported cases in the literature, nevertheless, it represents a devastating complication. There is no effective treatment for the filler-induced blindness and ophthalmoplegia. However, retrobulbar hyaluronidase treatment has been used with some apparent beneficial results. We report a case of a 29-year-old female patient who presented with right eye blindness, ophthalmoplegia, and ptosis secondary to dorso-nasal hyaluronic acid injection as a cosmetic treatment. She was treated immediately with intravenous corticosteroids and dorso-nasal and retrobulbar hyaluronidase in an outpatient clinic. After 6 days, the patient was admitted to our institution with a clinical diagnosis of ptosis, ophthalmoplegia, ischemic ocular syndrome, and ophthalmic and central retinal artery occlusion in her right eye. The ptosis and eye movements improved on her follow-up, but the vision loss was permanent due to severe optic nerve and retinal ischemia. Brain MRI ruled out central nervous system involvement.