Commentary on: Efficacy of Retrobulbar Hyaluronidase Injection for Vision Loss Resulting from Hyaluronic Acid Filler Embolization

The problem of sudden loss of vision associated with cosmetic facial filler treatments is a rare event that strikes fear in most of us. As of this writing, there are no known effective treatments for patients with blindness, although several authors have promoted retrobulbar injections of hyaluronidase.^1,2 As far as I am aware, patients with total blindness − no light perception (NLP) − at presentation have not responded well to any treatment protocol. In contrast, partial success is not uncommon in patients with only partial visual field obstruction at presentation (in short, NLP seems to be a very bad prognostic indicator). It is not clear whether the treatment was responsible for the observed improvement, since there are no control groups in these scattered case reports, and some patients with partial defects improved spontaneously with only supportive care. This article consists of a report of four cases of filler associated vision loss treated (unsuccessfully) with retrobulbar hyaluronidase (HYAL) and a thoughtful review of the literature.³ The authors argue that retrobulbar HYAL is ineffective.