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. 

• 4 cases of blindness from filler
• more than 4 hours post blindness - referred for retrobulbar injection of hyaluronidase
• no recovery from blindness in all 4 cases
• https://www.ncbi.nlm.nih.gov/pubmed/28333176

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.