Lee Ko-Eun, Kim Gye-Jung, Sa Ho-Seok
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Cosmet Dermatol. 2021 May;20(5):1532-1540. doi: 10.1111/jocd.14019. Epub 2021 Mar 20.
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.
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.
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.
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.
面部注射后可发生眶周血管阻塞导致的严重并发症，包括皮肤坏死、眼肌麻痹、上睑下垂和视力丧失。面部填充剂注射后视力丧失尤为罕见，但已知尽管进行了治疗，其预后仍较差。
本研究旨在描述面部注射美容填充剂或局部麻醉剂后眶周血管并发症的预后及各种临床特征。
患者/方法：本单中心回顾性研究纳入了10例面部注射后出现眶周血管阻塞的连续患者。
9例患者注射了面部美容填充剂：7例注射透明质酸，1例注射胶原蛋白，1例注射聚左旋乳酸。另1例患者注射了利多卡因加肾上腺素。注射部位包括眉间（n = 5）、鼻背（n = 4）和颞窝（n = 1）。推测受影响的动脉包括中央（n = 2）或分支（n = 3）视网膜动脉、眼动脉（n = 4）和角动脉（n = 1）。9例患者（90%）出现紫癜和水疱，8例患者（80%）就诊时出现眼肌麻痹，但均在3个月内恢复。6例患者（60%）在最后一次随访时失明，其中5例中央视网膜动脉或眼动脉阻塞。有1例患者出现眼球痨后遗症，通过球后填充剂注射进行了美容治疗。
面部注射可导致眶周动脉阻塞，其临床特征因血管阻塞的部位和范围以及注射材料而异。视力预后与血管阻塞部位和初始视力有关。其他常见并发症，如皮肤病变、上睑下垂和眼球运动受限，在大多数情况下仅通过支持性治疗即可完全缓解。
