Ophthalmic Artery Embolism due to Dermal Filler

This is Dr. Cal Shipley with a review of dermal filler embolism to the ophthalmic artery.

To get the most out of this presentation, I’d recommend that you review my videos VAS301 on the vascular anatomy of the eye and face, and VAS302 on dermal filler injections, before viewing this one.

What Is An Embolism

Let’s start this segment with the definition of an embolism. An embolism is a blood clot, or a piece of biological or a foreign material, which travels through the bloodstream and lodges in an artery. Most commonly, in the artery involved, the embolism results in partial or complete obstruction to blood flow beyond the point where the embolus has become lodged.

Ophthalmic Artery Embolism with Dermal Fillers

Let’s examine the mechanism of embolism in dermal filler injections.

The technique employed in dermal filler injections involves the insertion of a relatively fine needle, often 27 gauge, into the deep dermis beneath the wrinkle being treated.

Arteriole Shearing

As the needle advances, it may shear off one or more arterioles among the dense web of blood vessels present in the deep dermis. In this example, ArteFill has been used as the dermal filler of choice. The sheared arterioles do not interfere with the placement of the dermal filler. 

One or more of the sheared arterioles in the deep dermis may communicate with the tunnel created by the advancing needle. As the dermal filler enters the tunnel under pressure, particles of it may be pushed into the sheared arteriole. These particles travel to larger arterioles and ultimately into a nasal artery. [silence] From the nasal artery, the particles may travel to one of dozens of possible alternate routes with no effect on the eye.

If, however, the particles travel a route which leads to the ophthalmic artery, they may be pushed into the central retinal artery, and hence,  into arteries supplying blood flow to the retina. The particles have embolized to the retina and by obstructing its blood flow may result in significant impairment of vision or even blindness. The process of embolism takes just seconds. 

Ophthalmic Artery Embolism Dermal Filler Agents

Embolism to the ophthalmic artery with subsequent visual impairment may occur with any of the agents commonly in use, including hyaluronic acid gel and human fat. 

Due to the extensive interconnections of the arteries in the face, a dermal filler related ophthalmic artery embolism is theoretically possible from almost any injection site.

Incidence of Ophthalmic Artery Embolism due to Dermal Fillers

It is very important to note that blindness as a result of dermal filler injection in the face is exceedingly rare, with about 200-400 cases reported worldwide out of many millions of injections done. The number of cases of partially impaired vision after dermal filler injection is undoubtedly higher, but these cases still represent just a tiny fraction of the overall number of injections done worldwide.

Cal Shipley, M.D. copyright 2020