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How cosmetic fillers may cause blindness

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(REUTERS/Jim Young)

Injecting fillers into the forehead to remove wrinkles can have rare but devastating consequences for the eye and cause permanent blindness, according to a new report of three people who lost their vision due to this procedure.

Injecting fat, collagen or special cosmetic products under the skin for facial rejuvenation is an extremely common procedure and is fairly safe, with side effects usually limited to bruises or swelling of the skin.

However, the Food and Drug Administration approves the fillers only for the middle parts of the face, for example around the mouth. These materials are not approved for use around the eye area, yet they are commonly used as "off-label" by doctors for correcting wrinkles around the eye and on the forehead, said study author Dr. Michelle Carle, an ophthalmologist at Retina Vitreous Associates Medical Group in Los Angeles.

When injected in the area around the eye, the fillers may accidentally get into small blood vessels on the face, and find their way into the eye's artery and block its blood supply, Carle said.

"While this complication is very rare, it is very significant. A bruise will go away, but vision loss is permanent," Carle told Live Science. Doctors should discuss with their patients that there's a small risk of damage to the eye with such procedures, she said. [14 Oddest MedicalCaseReports]

Carle and her colleagues treated three patients who permanently lost their vision in one or both eyes after having a cosmetic facial enhancement.

One of their patients was a woman in her mid-40s. She had received an injection of bovine collagen and a dermal filler product called Artefill to remove her forehead creases. After the injection was complete, she opened her eyes and could not see with her right eye, according to the report published March 6 in the journal JAMA Ophthalmology.

Another patient, a man in his 30s, visited the doctors after he lost part of his vision in his left eye, following an injection of a gel called hyaluronic acid. Doctors found that the blood supply to parts of the man's retina had been blocked.

Similarly, a healthy woman in her 60s experienced severe loss of vision after receiving fat injections around her hairline, researchers said.

Because of the intricate web of arteries and vessels around the eye, any injection done in that area poses a risk of material entering the eye artery. The visual effects of a blockage in the arteries are devastating and irreversible in otherwise healthy patients, the researchers said.

In general, complications from these increasingly common procedures are rare, but cases of blindness, stroke and even death have been previously reported, researchers said.

"We recommend that blindness or significant visual loss be added as a risk when discussing these procedures with patients, because these are devastating consequences," the researchers said.

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