Ocular complications following facial dermal filler injections: a systematic review and proportion meta-analysis of visual and neurologic outcomes

Abstract

Background Facial dermal fillers are widely used for aesthetic procedures but can rarely cause severe ocular and cerebral vascular complications. This systematic review and meta-analysis evaluated the spectrum of ocular complications and quantified permanent vision loss and brain infarction following facial dermal filler injections. Methods PubMed/MEDLINE, Scopus, and Web of Science were searched from inception, supplemented by manual searching. Studies reporting ocular or neuro-ophthalmic complications following facial dermal filler injections were included. Data on filler type, injection site, complications, treatment, and visual outcomes were extracted. Methodological quality was assessed using Joanna Briggs Institute tools. Random-effects proportion meta-analyses were performed using logit transformation. Results Sixteen studies involving 81 patients were included. Ophthalmic artery occlusion and central retinal artery occlusion were the most frequently reported complications. The pooled proportion of permanent vision loss was 0.57 (95% CI, 0.45–0.68), while brain infarction occurred in 0.27 (95% CI, 0.19–0.38). Subgroup analysis showed no significant difference in permanent vision loss among autologous fat, mixed fillers, and hyaluronic acid fillers (χ 2 = 0.22, p = 0.9738). High-risk injection sites predominantly included the glabellar and nasal regions. Despite varied treatments, including hyaluronidase and intra-arterial therapy, visual recovery was limited. Conclusions Facial dermal filler–related ocular complications can result in devastating and frequently irreversible visual outcomes, with associated cerebral ischemic events in a substantial proportion of patients. No significant difference in visual outcomes was observed between filler types. Prevention, anatomical knowledge, careful injection technique, and early recognition remain essential to reduce morbidity.