Color Doppler flow imaging may help track complications from facial filler injections

This study evaluated how retinal artery occlusions caused by cosmetic facial filler injections affect retrobulbar blood flow parameters.

Study design

The authors present a retrospective case series of 10 consecutive patients with artery occlusions caused by autologous fat or hyaluronic acid injections. The patients were evaluated within 72 hours of injection. Color Doppler imaging was used to measure peak systolic and end diastolic velocity of the ophthalmic, central retinal and posterior ciliary arteries. Results were correlated to clinical findings.

Outcomes

The 6 patients with ophthalmic artery occlusion showed no or severely reduced retrobulbar blood flow. Despite partial blood flow recovery in some patients, visual acuity remained at no light perception in each case. Color Doppler showed decreased velocities in the 3 patients with central retinal artery occlusion (CRAO).

Limitations

The initial visit and follow-up times were not standardized, so the results reflect findings at different stages after occlusion. Moreover, the exact location of the embolism cannot be identified with color Doppler imaging.

Clinical significance

Color Doppler imaging in cases of filler-induced blindness shows changes in blood flow that are consistent with clinical findings. Subsequent improvement in blood flow may occur, as may improvement in ptosis and ophthalmoplegia, but it is not associated with any improvement in vision. This modality could be used in the future to follow interventions for this devastating complication of facial filler injections.