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Awareness of management of hyaluronic acid induced visual loss: A British National Survey



Visual loss from aesthetic hyaluronic acid filler injections is an under-reported complication. Our study surveyed British Oculoplastic consultants and Consultant members of the British Eye Emergency Care Society, on their awareness of visual vascular complications of dermal fillers and its emergency management.


A prospective survey of the members of the British Oculoplastic Society and the British Eye Emergency Society, using the Survey Monkey platform.


There were 53 responses. Eighty five percent of responders were aware of ophthalmic artery occlusion and visual loss as a recognised complication of hyaluronic acid based fillers. Six respondents had encountered at least one case of visual loss associated with HA fillers. Approximately 27% of the respondents had some experience of the recommended appropriate management of this complication. Majority of these practitioners did not have local management guidelines for this complication (88%) nor were they aware of guidance to manage the complication (75%).


This survey captures the current experience of British Ophthalmologists and Oculoplastic Surgeons in the management of visual vascular complication with dermal fillers. This may relate to the rarity of this complication. Although there is an awareness of visual loss as a complication from aesthetic dermal fillers, there appears to be a lack of knowledge of current management guidelines across Eye Specialists in UK. It is important for practitioners to be able to recognise and manage vascular compromise and further study recommendations are made.

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Fig. 1


  1. 1.

    Fakih-Gomez N, Orte-Aldea MC, Poonja K, Khanna D. Hyaluronic Acid Filler Emergency Kit. Am J Cosmet Surg. 2019;118:71–6.

    Google Scholar 

  2. 2.

    King M, Convery C, Davies E. This monthʼs guideline: The Use of Hyaluronidase in Aesthetic Practice. J Clin Aesthet Dermatol. 2018;11:E61–8.

  3. 3.

    Hirsch RJ, Brody HJ, Carruthers JDA. Hyaluronidase in the office: a necessity for every dermasurgeon that injects HA. J Cosmet Laser Ther. 2007;9:182–5.

    Article  Google Scholar 

  4. 4.

    Park SW, Woo SJ, Park KH, Huh JA, Jung C, Kwong OK. Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol. 2012;154:653–62.

    Article  Google Scholar 

  5. 5.

    Park KH, Kim YK, Woo SJ, Kang SJ, Lee WK, Korean Retina Society. Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol. 2014;132:714–23.

  6. 6.

    Zhu GZ, Sun ZS, Liao WX, Cai B, Chen CL, Zheng HH, et al. Efficacy of retrobulbar hyaluronidase injection for vision loss resulting from hyaluronic acid filler embolization. Aesthetic Surg J. 2017;38:12–22.

    Article  Google Scholar 

  7. 7.

    Myung Y, Yim S, Jeong JH, Kim BK, Heo CY, Baek RM, et al. The classification and prognosis of periocular complications related to blindness following cosmetic filler injection. Plast Recon Surg. 2017;140:61–4.

    CAS  Article  Google Scholar 

  8. 8.

    Lazzeri D, Agonstini T, Figus M, Nardi M, Pantaloni M, Lazzeri S. Blindness following cosmetic injection of the face. Plast Reconstructive Surg. 2012;129:995–1012.

    CAS  Article  Google Scholar 

  9. 9.

    Humzah MD, Ataullah S, Chiang C, Malhotra R, Goldberg R. The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): a consensus on practical guidance. J Cosmet Dermatol. 2019;18:71–6.

    Article  Google Scholar 

  10. 10.

    von Bahr G. Multiple embolisms in the fundus of an eye after an injection in the scalp. Acta Ophthalmol (Copenh). 1963;41:85–91.

  11. 11.

    Belezany K, Carruthers JDA, Humphrey S, Jones DJ. Avoiding and treating blindness from fillers: a review of the world literature. Dermatologic Surg. 2015;41:1097–117.

    Article  Google Scholar 

  12. 12.

    Loh KTD, Chua JJ. Prevention and management of vision loss relating to facial filler injections. Singap Med J. 2016;57:438–43.

    Article  Google Scholar 

  13. 13.

    Cohen JL, Biesman BS, Dayan SH, DeLorenzi C, Lambros VS, Nestor MS, et al. Treatment of hyaluronic acid filler-induced impending necrosis wth hyaluronidase: consensus recommendations. Aesthet Surg J. 2015;35:844–9.

    Article  Google Scholar 

  14. 14.

    Beleznay K, Humphrey S, Carruthers J, Alastair C. Vascular compromise from soft tissue augmentation. J Clin Aesthetic Dermatol. 2014;7:6.

    Google Scholar 

  15. 15.

    Chen Y, Wang W, Li J, Yu Y, Li L, Lu N. Fundus artery occlusion caused by cosmetic facial injections. Chin Med J. 2014;127:1434–7.

    PubMed  Google Scholar 

  16. 16.

    Carruthers J, Fagien S, Dolman P. Retro or Peri Bulbar injection techniques reverse visual loss after filler injections. Dermatol Surg. 2015;41(suppl 1):S354–7.

    Article  Google Scholar 

  17. 17.

    Fagien S, Carruthers J. Commentary on restoration of visual loss with retrobulbar hyaluronidase injection after hyaluronic acid filler. Dermatol Surg. 2018;44:437–43.

    CAS  Article  Google Scholar 

  18. 18.

    Chesnut C. Restoration of visual loss with retrobulbar hyaluronidase injection after hyaluronic acid filler. Dermatol Surg. 2018;44:435–7.

    CAS  Article  Google Scholar 

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Correspondence to Sabrina Shah-Desai.

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Joganathan, V., Shah-Desai, S. Awareness of management of hyaluronic acid induced visual loss: A British National Survey. Eye 34, 2280–2283 (2020).

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