To bring awareness to the newly emerging etiology of iatrogenic central retinal artery occlusion (CRAO) as a consequence of cosmetic dermal filler injections.

Permanent blindness is a rare complication from an aesthetic augmentation of the face by dermal filler injections such as hyaluronic acid. The injury is due to differences between the injection and arterial pressures causing filler to move against blood flow from terminal branches to the origin of the central retinal artery. We present a case of iatrogenic right CRAO in a woman who underwent facial augmentation with hyaluronic acid injections.

Case report.

A 59-year-old woman with cardiovascular risk factors presented with the acute onset of right eye blindness after hyaluronic acid injections to the supraorbital region. Within 10 minutes of injections, complete vision loss, dizziness, nausea, vomiting and severe frontal headache occurred. She received hyaluronidase to the affected area before transfer. She arrived at our institution 120 minutes after her initial injections. 

On examination, no light perception and a minimally reactive pupil with afferent pupillary defect in the right eye were noted. Fluorescein angiography revealed a pale right retina and occlusion of the supratrochlear artery. MRI orbits showed restricted diffusion of the intraorbital segment of the right optic nerve. MRI brain was noted for few scattered punctate infarcts in the right frontal and occipital lobes consistent with watershed infarctions. Cerebral angiogram and venous studies were unremarkable. The diagnosis of CRAO as a procedural complication due to retrograde embolism was made. She was treated with topical nitroglycerin paste, warm compresses, eye massage and aspirin 325 mg. No improvement in her vision on two month follow-up was noted.

As cosmetic procedures become more common, awareness of adverse neurological events such as CRAO is essential to making prompt diagnosis as there is only a 90-minute window before blindness is irreversible.