10/06/2026
✋🛑🚦BE VERY VERY CAREFUL. You pay for skills and experience not for quantity when asking for nose filler ! Be careful!Pain in the eye during filler procedures is the clinical picture you do not wait on. Most filler-induced vision loss occurs immediately or within 10 minutes of injection.
The question is not whether to act, it is how fast you move.
What you do now:
Stop injecting. Patient supine. No massage, no reassurance that this is probably nothing. Don’t f***y about asking the patient to describe their vision while you work out what to do. Move.
Get yourself and the patient to nearest ED. Don’t call 999, take them yourself. The updated UK guidelines are explicit - you accompany the patient to A&E yourself, and you bring at least 7,500 IU of Hyalase with you. Faster handover, Hyalase on hand, ED aware of the urgency.
While preparing to leave:
- Timolol 0.5% - one drop to the affected side
- Paper bag rebreathing - 10 minutes every 30 minutes
- Ocular massage - pressure over closed eyelid, 5 seconds on / 10 seconds off, up to 5 minutes, patient supine at 15-45 degrees
- Aspirin 300mg oral if no contraindication
- Periocular hyalase at the injection site or near the supraorbital notch / supratrochlear vessels IF competent and it would not delay transfer
What you do NOT do:
- Retrobulbar hyalase - risk of ocular perforation, limited evidence of benefit, really bloody difficult even if you know what you are doing
- Visual acuity or pupil testing - unlikely to change management, delays transfer
- Wait to see if it settles
Why A&E and not eye cas:
Case series report up to 24% of filler-induced blindness cases have coexisting stroke. Your destination should be a main A&E with stroke pathway access, not a standalone eye unit.
Your consent for every filler procedure should include vision loss AND stroke. If it does not yet, today is the day to update your forms.
Reference: Sansome S, Clague M, Convery C, Davies E, Fairris C, Goodman G, Harris S, Hawkes E, Hay G, Murray G, Shah-Desai S, Vize C, Walker L, Neffendorf JE. Aesthet Surg J 2026;46(5):563-568.
