Management of Visual Loss Following Hyaluronic Acid Filler Injections: An Algorithm-based Approach

Background: Hyaluronic acid (HA) filler injections have been associated with the rare but vision-threatening complication of retinal artery embolism. Clinical management of this condition remains challenging due to the lack of high-level evidence. Randomized controlled trials are neither ethically justifiable nor practically feasible, and current treatment recommendations are derived almost exclusively from individual case reports and small case series. Methods: The aim of this article is to offer evidence-informed recommendations for the management of central retinal artery occlusion following HA filler injections. These recommendations are intended for both aesthetic practitioners and in-hospital specialists and are structured as stepwise treatment algorithms, based on published reviews and expert opinions as well as the clinical experience of the authors. Results: Algorithms are provided and organized into 2 sequential tiers: outpatient management and in-hospital management. Conclusions: These guidelines are not intended to be complete or exhaustive but may prove informative for aesthetic physicians and in-hospital specialists who are responsible for treating patients with HA filler–induced central retinal artery occlusion. They should be regarded as a basis for treatment and discussion by clinicians, providing clear guidance under conditions of uncertainty.