Permanent Vision Loss Due to Vascular Variation After Ear Hyaluronic Acid Injection: Two Case Reports and Literature Reviews.

backgroundIn line with modern aesthetic principles, a prominent and voluminous auricle is considered to enhance facial structure by making it appear smaller and more refined. Recently, there has been a growing trend toward using injectable treatments as an alternative to traditional surgical procedures for correcting lying ears. This shift has led to an increase in reported complications associated with these interventions. OBJECTS: This report aims to investigate the mechanisms leading to vision loss following hyaluronic acid (HA) injections in the ear and to propose preventive measures and countermeasures.

methodWe present two rare cases of blindness following HA injections into the ears. The first patient experienced vision loss in both eyes, while the second suffered unilateral blindness in the left eye. In both cases, local hyaluronidase injections were promptly administered. Ophthalmological evaluations revealed central retinal artery occlusion, followed by arterial thrombolysis treatments performed 3 and 6 h post-diagnosis, respectively. Postoperative management included daily interventions to reduce intraocular pressure, promote vasodilation, enhance nerve nourishment, and provide hyperbaric oxygen therapy.

resultsDigital subtraction angiography revealed structural variations in the ophthalmic arteries of both patients, which we hypothesize to be the primary cause of their blindness. In Case 1, the bilateral ophthalmic arteries and, in Case 2, the left ophthalmic artery were found to primarily originate from the external carotid artery. After treatment, Patient 1 exhibited a detectable index in the right eye, whereas the left eye was limited to light perception. Patient 2 showed recovery, with only defects in the inferior quadrant of the left eye.

conclusionThe administration of filler injections in the auricular region is considered a high-risk aesthetic procedure due to the dense network of blood vessels and nerves, and significant anatomical variations. The use of large volumes of HA in this confined space can compress vascular structures and nerves, potentially leading to visual impairment. Therefore, ear filler injections are not recommended as a routinely substitute for the surgical correction of lying ears. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .