Aesthetic Surgery Journal (ASJ)Vision Loss Following Nonsurgical Rhinoplasty Injections: Systematic Review of Cases and Management

⚠️ Rare but High Risk Safety Event

Investigators conducted a systematic review examining published cases of vision loss following nonsurgical rhinoplasty with dermal fillers. From nearly 1,500 screened articles, 21 publications describing 22 cases met inclusion criteria. The review focused on patient characteristics, injection sites, filler types, management strategies, and visual outcomes. Most events occurred immediately after injection, suggesting acute vascular compromise as the likely mechanism of injury. Although several treatment approaches were reported, including hyaluronidase, corticosteroids, antibiotics, and hyperbaric oxygen therapy, visual recovery remained uncommon. As a review of published cases, the findings primarily characterize the severity and outcomes of this complication rather than compare treatment effectiveness.

Clinical Considerations

• Vision loss occurred immediately after injection in 82% of reported cases, underscoring the rapid onset of this complication.
• Hyaluronic acid accounted for 50% of cases, making it the most commonly reported filler associated with visual injury.
• The nasal bridge or dorsum was the most frequently reported injection location, followed by the glabellar region.
• Only 27% of patients achieved complete visual recovery, with recovery requiring an average of more than five months.
• Commonly reported interventions included hyaluronidase, corticosteroids, and antibiotics, though outcomes were often poor.
• Hyperbaric oxygen therapy was identified as a potential area for further investigation, but evidence remains limited and insufficient to establish effectiveness.

Practice Applications

• Recognize vision loss following filler injection as a rare but potentially catastrophic medical emergency.
• Review facial vascular anatomy and high-risk injection zones when discussing interdisciplinary referral or complication pathways.
• Interpret current management evidence cautiously, as published reports do not establish a consistently effective treatment strategy.
• Monitor patients reporting immediate visual symptoms following cosmetic filler procedures for urgent ophthalmic assessment.
• Discuss the limitations of available rescue interventions when counseling patients regarding procedural risks.