Case Study - Published by Dr Cameron Chesnut MD FAAD FASDS
Derm Surg. 2018:44:435-436
Dr Cameron Chesnut published a case study of reversal of blindness after injection of Hyaluronidase.
Description
- 39 Year old woman
- receiving HA filler injection in her midface (near inra-orbital neurovascular bundle)
- Patient noticed visual changes
- Progressed to full visual loss
- Experienced Injector - who then contacted Dr Chesnut
- Patient referred to Dr Chesnut - arrives at his clinic 20 mins after reporting visual loss
- No signs of impending necrosis in other tissues
- Obvious right eye pain
- Using a 32 g half inch needle Dr Chesnut injected 150 units of Hylenex into the infra-orbital foramen area where the filler was placed (150units per 0.1ml)
- Followed by a second injection of 150 units Hylenex into the supra-orbital notch from
- a third injection - retrobulbar with a 27 gauge 1 1/2 inch needle 150 units of Hylenex
- a fourth injection - retrobulbar as above - 150 units Hylenex
- Shortly after the secondinfraorbital injection the patient noted return of light vision
- a third retrobulbar injection of 450 units of Hylenex was performed based on the above improvement
- Patient recovered full vision, was given aspirin and referred for MRI and neurological exam
- Patient receovered fully
- https://www.ncbi.nlm.nih.gov/pubmed/28333176
Importantly -
- They had a protocol for visual loss after HA filler
- They executed quickly (less than 20 mins from first visual loss)
- They kept trying
- They used large doses of hyalruronidase
- They didn't have time to do a full visual assessment upon arrival. The nature of this adverse event has caused fast treatment to try and resolve symptoms and permanent blindness.
- 23.5% of blindness cases also experience neurological side effects such as stroke
- The author frequently performs frequent peri-bulbar injections, but first time performing retrobulbar injection
Other Retrobulbar injection clinical paper - Zhu et al (Aesthetic Surg Journal 2017) - 4 cases of blindness from HA filler.
Bottom line - from these 2 publications it appears retrobulbar injection of hyaluronidase may be effective to treat blindness from HA fille rin under 20 mins. The Zhu paper indicates that more than 4 hours may be too late for treatment with hyaluronidase in a case of blindness from HA dermal filler.
