The clinical spectrum of periorbital vascular complications after facial injection

Background Serious complications due to periorbital vascular occlusion can occur after facial injections, including skin necrosis, ophthalmoplegia, blepharoptosis, and visual loss. Visual loss after facial filler injection is particularly rare, but it is known to have a poor prognosis despite treatment. Aims This study aimed to describe the prognosis and various clinical features of periorbital vascular complications after facial injection of cosmetic filler or local anesthetic. Patients/Methods This single‐center retrospective study included 10 consecutive patients who presented with occluded periorbital vessels after facial injection. Results Nine patients were injected with cosmetic facial fillers: seven with hyaluronic acid, one with collagen, and one with poly‐Llactic acid. The other patient was injected with lidocaine mixed with epinephrine. Injection sites included the glabella (n = 5), nasal dorsum (n = 4), and temporal fossa (n = 1). Presumed arteries affected included the central (n = 2) or branch (n = 3) retinal artery, ophthalmic artery (n = 4), and angular artery (n = 1). Nine patients (90%) had purpura and blisters, and eight patients (80%) had ophthalmoplegia at presentation, but all of them recovered within 3 months. Six patients (60%) were blind at the last follow‐up, and five of them had occlusion of the central retinal artery or ophthalmic artery. There was a patient with sequelae of phthisis bulbi, which was cosmetically managed with retrobulbar filler injections. Conclusion Facial injections can cause periorbital arterial occlusion, and the clinical features are diverse according to the site and extent of vascular occlusion and injection materials. Visual prognosis was associated with the site of vascular occlusion and initial visual acuity. Other common complications, such as skin lesions, blepharoptosis, and limited extraocular movement, can fully resolve only with supportive treatments in most cases.