Sensory exotropia often develops after filler-induced ophthalmoplegia

This study investigated the natural course of ophthalmoplegia after iatrogenic ophthalmic artery occlusion resulting from facial filler injection.

Study design

The authors retrospectively reviewed the charts of 21 patients who suffered an occlusion of the ophthalmic artery after cosmetic facial filler injection, focusing on the characteristics and prognosis of ophthalmoplegia and sensory strabismus. Ophthalmoplegia was graded at the initial visit and at least 3 months after injection on a scale of 1 to 4.

Outcomes

All patients were women with a mean age of 33 years (range 19–66 years); 67% of patients underwent hyaluronic acid filler injection. The most commonly injected sites were the glabella (33%), nasal dorsum (29%) and nasolabial fold (14%).

Patients exhibited an ophthalmic or central retinal artery occlusion (76%), total blindness (67%) and ophthalmoplegia (71%). Ocular motility at least three months after occlusion showed full recovery in 77% of patients. However, after a full recovery, 46% of patients developed sensory exotropia.

Limitations

This study does not offer clues to the pathogenesis of filler-induced blindness or ophthalmoplegia. The ophthalmoplegia was measured very crudely, and the results are limited by its retrospective in nature.

Clinical significance

While filler-induced blindness tends not to improve, ophthalmoplegia may recover. Unfortunately, because of the blindness, about half of patients go on to exhibit sensory exotropia. Filler-induced visual complications continue to represent a rare but devastating result of filler injections.