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

Abstract Background 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. Objective 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). Methods 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. Results 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. CONCLUSION: EYE-CODE provides an up-to-date, one-stop reference for appropriate management of retinal artery occlusion induced by injection of soft-tissue fillers.