Systematic review and meta-analysis of ocular complications following hyaluronic acid filler injection.

[BACKGROUND] Hyaluronic acid (HA) filler injections are widely known to be safe; however, they cause rare and severe complications such as visual loss. No standardized treatment protocol has been established because of the rarity and heterogeneity of these cases. In this study, the aim was to analyze cases of ocular complications related to HA fillers through a meta-analysis to inform the establishment of guidelines.

[METHODS] We conducted a systematic review and meta-analysis by searching PubMed/MEDLINE and Embase for eligible studies published between January 2000 and March 2025.

[RESULTS] Overall, 58 studies involving 232 unique patients were included. The pooled recovery rate of visual acuity was calculated from 13 studies (n = 179), with more than two patients each, and was estimated at 27.3% [95% CI: 18.1-37.3%]. Visual improvement was significantly associated with initial visual acuity and the type of arterial occlusion. The injection sites that were implicated in visual impairment were predominantly located in the nasal area (45.8%). Ptosis (81.2%) and limitation of extraocular movement (75.8%) were common accompanying complications. Cerebral infarction occurred in 35.0% of cases with available neuroimaging.

[CONCLUSIONS] Visual loss caused by HA filler injection is often irreversible, requiring rapid recognition and tailored treatment. Findings from this study, despite the heterogeneity of current treatment approaches, offer the most comprehensive aggregation to date. Additionally, it provides evidence to guide clinical vigilance and procedural safety.