Forehead hyaluronic acid filler and vision loss: understanding risk through real imaging

01

The case

A 22-year-old woman experienced sudden loss of vision in her left eye during a hyaluronic acid filler injection in the left forehead. More than four days had passed by the time she arrived at our hospital. Imaging shows retained screws and plates from previous mandibular and zygomatic arch surgery.

These implants document previous surgery; they are not presented as the direct cause of this episode of vision loss.

02

Vascular connections from forehead to eye

Facial and ocular arteries are connected. If filler accidentally enters an artery, injection pressure may drive it backwards, after which it can enter branches supplying the eye and cause severe visual damage.[2]

The animation illustrates a possible mechanism. It does not establish the exact site of embolization in this patient.

03

What to do if vision changes

Stop the injection, accurately record symptom onset, call emergency services (120 in China), and seek emergency care promptly. Do not wait for vision to recover on its own. Assessment may involve ophthalmology, emergency medicine and cerebrovascular specialists, according to the clinical situation.[2]

04

CRAO and the importance of time

CRAO means central retinal artery occlusion. The 2026 Chinese neurointerventional expert consensus recommends urgent assessment and treatment within six hours for eligible patients with non-arteritic CRAO; patients presenting later still require urgent, individualized assessment. The six-hour window here primarily concerns assessment for intra-arterial treatment; other treatments have their own eligibility criteria and timing.[1]

Twenty-four hours is neither a universal cutoff nor a period during which it is safe to wait.

Hyaluronic acid embolization requires cause-specific management. Conventional thrombolysis does not dissolve hyaluronic acid. A treatment window for conventional CRAO does not guarantee effective treatment for a filler embolus.[2]

The Department of Cerebrovascular Diseases at Shanghai General Hospital, North Campus, provides assessment and care for CRAO, including evaluation for thrombolysis. Decisions depend on the cause, time of onset, ocular findings and bleeding risk. Earlier assessment is better; suitability and potential benefit must be assessed by the treating team.

05

An informed decision

Before an aesthetic procedure, understand its serious complications and the arrangements for emergency care and transfer. Informed consent is more than a signature: it means understanding the risks before choosing.