Vision Loss Following Nonsurgical Rhinoplasty Injections: Systematic Review of Cases and Management.

Abstract

Vision loss following nonsurgical rhinoplasty with dermal fillers is a rare but catastrophic complication. This systematic review synthesizes reported cases of visual impairment after nasal filler injection, focusing on mechanisms of injury, risk factors, management strategies, and outcomes. A systematic search of Scopus, Ovid Medline, and CINAHL was performed using terms related to visual changes, dermal fillers, and nonsurgical rhinoplasty. After duplicate removal, 1,498 unique articles were screened using predefined inclusion and exclusion criteria. Data were extracted independently by three reviewers, and descriptive statistics summarized patient demographics, injection sites, filler types, treatments, and outcomes. Twenty-one articles met inclusion criteria, comprising 22 cases of vision loss. The mean patient age was 33.4 years, and 90.9% of patients were female. Hyaluronic acid was the most commonly used filler (50%). Vision loss occurred immediately after injection in 82% of cases. Injection site was reported for 18 patients (86%), with 5 patients (24%) receiving injections in multiple locations. The nasal bridge or dorsum was the most frequent injection site (12 patients, 57%), followed by the glabellar region (6 patients, 29%). Full visual recovery occurred in only 27% of cases, requiring an average of 5.3 months. Vision loss was often immediate and irreversible despite treatment with hyaluronidase, corticosteroids, and antibiotics. Hyperbaric oxygen therapy showed promise and warrants further study. Prevention through careful technique, detailed anatomical knowledge, and prompt intervention remains essential.