The SAFER Protocol for Occular Symptoms following Hyaluronic Acid Filler Injection
Kathleeya Stang – Veldhouse, MD, MPH Oculoplastic and Reconstructive Surgery Clinical Lead, ADHB Acute Eye Service.
S – top the injection at the first sign of compromise
A – assess visual acuity, pupils, motility, & cranial nerves
F – facilitate transfer to the nearest ophthalmologist within 90 minutes of symptom onset.
E – nzymatic degradation with hyaluronidase immediately
R – educe intraocular pressure prior to & during transfer
Contact details – as seen in contact details topic here.
Sample Script for Discussion with Ophthalmologist
“A patient has just received an injection of hyaluronic acid dermal filer to (anatomical location) and developed cute visual symptoms including (visions loss; diplopia; ptosis) Visual acuity is (6/15;CF;HM;NPL) The pupils are (reactive/abnormal) I am concerned about an embolic event involving the ophthalmic artery and its collateral circulation”
“Current recommendations as given bt the Auckland District Health Board’s Department of Ophthalmology advise for transfer to an ophthalmologist for evaluation and consideration of a retrobulbar injection of hyaluronidase WITHIN 90 MINUTES OF ONSET OF SYMPTOMS. Do you have hyaluronidaise on-site?”
Send 1-2 vials of hyaluronidaise with the patient if necessary for possible retrobulbar injection. Urban practices should have 3 vials of hyalase on-site at all times; Rural practices are expected to carry 5 vials on-site.
Reduce Intraocular Pressure During Transfer
1. Perform ocular massage
Firm pressure with thumb over closed eyelids (5 seconds on/5 seconds off)
2. Administer Oral Diamox 500mg PO STAT
Contraindications: severe renal/hepatic impairment, recurrent nephrolithiasis and hyperkalemic acidosis
3. Have the patient breathe into a paper bag to increase carbon dioxide content and encourage vasodilation
She also has an eye chart on the back of her handout.
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