Restoration of Visual Loss with Retrobulbar HYaluronidase after HA filler

Author: Mike Clague BSC Aesthetic Nurse   Date Posted:14 October 2018 

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.


  • 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

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. 

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