Standardized Approach to Treatment of Retinal Artery Occlusion After Intra-Arterial Injection of Soft-Tissue Fillers: EYE-CODE.

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Inadvertent intra-arterial injection of soft-tissue fillers during facial aesthetic procedures can result in serious adverse events including visual impairment and blindness. Once the retinal artery has been occluded, only a short window of opportunity exists before blindness becomes irreversible. All physicians should be prepared for the eventuality of intra-arterial injection, despite its rarity.The aim of this document is to provide a simple and evidence-based protocol using the easy to remember acronym EYE-CODE: EYE (I call retinal referral center), C (check vision), O (optic nerve function), D (decrease intraocular pressure), E (erase filler).AND MATERIALS: The EYE-CODE acronym incorporates two key components: 1) a systematic office-based protocol to first determine whether vision loss is present and to what extent, and 2) a treatment strategy that can be started in the acute office setting and continued by an emergency ophthalmologist.The protocol incorporates a ‘crash kit’ of treatments readily available to an aesthetic physician combining measures to rapidly reduce intraocular pressure to allow the emboli to dislodge downstream, with those to improve retinal perfusion.EYE-CODE provides an up-to-date, one-stop reference for appropriate management of retinal artery occlusion induced by injection of soft-tissue fillers.

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