NZSCM Blindness Advice

[Stacey Power]

Stacey Power

July 30, 2017 at 3:13 pm #169

NZSCM have recently had a meeting about filler and blindness. This is the outcome: Management of HA retinal artery embolism, and opportunities to improve our current practice and improve outcomes. The following points have been raised so far. More comprehensive protocols are in development: 1. The ADHB Eye Department is of the opinion that discussing the risk of blindness and stroke as a potential complication of dermal fillers should be part of everyone’s consent process – especially in treatment areas such as the glabella and nasal regions. 2. Data suggests that any attempt at retinal reperfusion (whether it be through medical or surgical reduction of intraocular pressure or consideration of retrobulbar hyalase) should be done within 90 minutes of onset of symptoms to preserve retinal function. Achieving this goal will require some preparation. In our practices we will need to be able to rapidly identify the fact that vision has been lost, and measure the eye vital signs; visual acuity, pupillary reflexes and, ideally, visual fields and eye movement. We need to be able to quickly contact our local Acute Eye Service, give them the details of what has occurred and the state of the patient’s vision, and commence transport (Auckland numbers are on the NZSCM website; we need to do this for the rest of the country). Prompt administration of oral acetazolamide (Diamox) 500 mg should be considered, provided the patient does not have a history of sulfa allergy, kidney stones, or severe liver dysfunction. During transport ocular massage and increasing inspired CO2 by getting the patient to breathe into a paper bag may promote some clearance of the embolism. In the past it has been advocated that experienced injectors may wish to inject retrobulbar hyalase themselves. The Auckland Acute Eye service advises against this given the risk of globe perforation and further ocular injury. With regard to our Eye Services being ready to provide treatment in a timely manner, a series of meetings will be held by acute and oculoplastic ophthalmologists in the coming months. The case will be presented again in Queenstown in August and further information will be available.

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