Cosmetic facial fillers used in “eye lifts” and other such procedures can often unleash a cascade of deleterious ocular effects, according to research. The materials injected into the lids and periocular area can paralyze the extraocular muscles, which leads to iatrogenic central retinal artery or ophthalmic artery occlusion approximately half the time. A third of patients will develop strabismus. Many patients will return to the surgery center to correct the strabismus, but a new study is showing not everyone can achieve the best results. When these patients develop strabismus, surgery is only successful when patients don’t have persistent ophthalmoplegia at the time of the procedure, the study shows.1

The study looked over the records of 23 patients who had suffered occlusion of the ophthalmic artery and its branches after undergoing cosmetic facial filler injections, six of whom underwent strabismus surgery. The investigators looked at the patients’ initial, preoperative and final ocular motility exams as well as what types of surgery they received and their outcomes. At initial presentation, five patients’ visual acuity was no light perception and one was merely hand motion. Five out of six patients showed initial ophthalmoplegia. Only three of those five patients’ eye motility fully recovered, although even they developed sensory strabismus. The remaining two patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2±1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, five of the six patients showed exotropia and one had esotropia. Vertical deviation was found in three in addition to the horizontal deviation.

Ultimately, successful outcomes were achieved in only the four patients without persistent ophthalmoplegia, 1.4±1.0 years after surgery. The other two failed to achieve successful alignment and one patient eventually underwent evisceration due to phthisis bulbi.

Yang H, Woo S, Kim S, Hwang J. Surgical outcomes of strabismus after iatrogenic ophthalmic artery occlusion caused by cosmetic filler injections. BMC Ophthalmol. December 16, 2019. [Epub ahead of print].