Can under-eye fillers really cause blindness? Medical reviews have reported real cases of vision loss after facial filler injections, so it shouldn't be considered impossible. This article answers this directly, explaining the most commonly reported locations, warning signs requiring immediate medical attention, steps to take in case of an accident, and the limitations of the claim that cannula reduces the risk. This is general knowledge, not a diagnosis.
Key Takeaways
- Blindness can indeed occur with fillers. Hundreds of cases have been reported in reviews, and in a recent study of 318 cases, more than two-thirds did not regain any vision, while the remainder recovered partially or completely.
- The most commonly reported locations are the nose, forehead, and between the eyebrows, but no confirmed source was found to indicate a low risk for the area under the eyes. The review noted that the blood vessels in this area are interconnected and can occur in any area of the face.
- Warning signs that require immediate medical attention include unusual pain, blurred or altered vision, drooping eyelids, inability to move the eyeball, skin discoloration (white, gray, or purplish), severe headache, or symptoms similar to a stroke. In particular, you should see an ophthalmologist immediately.
- Cannula injections are one measure recommended in reviews, but available sources do not confirm that they eliminate the risk, and there are reports of patients receiving injections via cannula.
Can under-eye fillers really cause blindness? The answer, according to a review.
Yes, blindness or vision loss after filler injections has been reported in the medical literature. A review by Kato and Matayoshi compiled 233 worldwide reports up to March 2020.[2] And a review by Doyon et al. found another 365 new reports published between September 2018 and March 2023.[3]
The clinic responded, "It's possible, but the chances are very low," and it's more likely to occur after injection into an artery connected to the eye, such as in the forehead, bridge of the nose, or between the eyebrows, rather than directly under the eye.[1] The possibility, and its common occurrence, concerning the forehead, nose, and between the eyebrows, aligns with available research reviews, but the term "very rare" lacks confirmed incidence figures, and the issue under the eyes will be explained further in the next section.
Regarding frequency, DeLorenzi stated that filler-induced vascular occlusion appears to be very rare, but the true frequency is unknown because patients underreport the actual occurrence.[6] A 2025 descriptive review of the sub-ocular and nasolabial fold area cited a visual loss range of 0.0001–0.01%, but this is a very broad range and is based on references to other studies, not on measurements within that specific study.[7] Therefore, this number should not be used as a measure of individual risk.
Understanding the severity of the situation is important. In Doyon's study of 318 patients with visual acuity data, 6.0% regained full vision, 25.8% showed partial improvement, and 68.2% showed no recovery.[3] Kato's study found that in 209 patients with a final visual acuity of 82.3%, they still had poor vision in one eye (less than or equal to 20/200).[2] All figures are derived from compiled patient reports. The total number of people who received filler injections is unknown, so it's impossible to say how many cases occur per ten thousand injections.
Where are the most reported locations, and under the eyes?
Several reviews counted injection sites in patients with vision loss. The table below summarizes the most common sites from each study. However, since each study counted different patient groups and time periods, a direct comparison of the figures is not possible.
| Review work | Number of patients counted. | Most common location |
|---|---|---|
| Beleznay et al., 2015.[5] | 98 cases | Between eyebrows 38.8%, Nose 25.5%, Nasolabial folds 13.3%, Forehead 12.2% |
| Beleznay et al., 2019.[4] | 48 new cases (January 2015 to September 2018) | Nose 56.31 TP3T, Interbrows 27.11 TP3T, Forehead 18.81 TP3T, Nasolabial folds 14.61 TP3T (Total exceeds 1001 TP3T, so some individuals may appear to be counted at multiple locations). |
| Kato and Matayoshi, 2022[2] | 233 cases (including only those who received a single injection site: 178 cases) | Nose 36.5%, Between eyebrows 27.0%, Forehead 20.2%, Nasolabial folds 7.3% |
| Doyon and colleagues, 2024.[3] | 365 new cases (September 2018 to March 2023) | Nose 40.6%, Forehead 27.7%, Between eyebrows 19.0% |
All studies consistently show that most patients received injections in the center of the face and forehead, which matches what the clinic stated.[1]
Is it safer to use the area under the eyes?
The clinic explains that blood vessels under the eye, such as the infraorbital artery and angular artery, are deeper than the skin layer, run along the bone, and are not directly connected to the ophthalmic artery that supplies the eye. Therefore, blindness from injections under the eye is less likely than from injections in the nose.[1] In publicly available sources, no information was found to confirm this claim, and there is information that suggests it is inappropriate to conclude that dark circles under the eyes are a low-risk area, as follows:
- Kato's review identified vulnerable vascular areas, including the mid-cheek (zygomaticofacial and infraorbital artery), and concluded that all areas of the face are susceptible to occlusion of blood vessels connecting to the eyes, even in experienced injectors.[2]
- A 2025 review of the under-eye and nasolabial fold area indicates the need to understand the connections between angular and infraorbital blood vessels to avoid filler clots obstructing the retinal arteries.[7]
- The review above did not include statistics on patients who had injections under the eyes. Therefore, the available data cannot provide numerical figures indicating whether the under-eye area is more or less at risk than other areas.[2][3]
- According to the U.S. FDA patient information page (last updated July 2023), filler injections around the eyes, between the eyebrows, nose, and forehead are not approved in the U.S. and are not recommended. Approval varies by country, so you should ask your doctor whether the product is permitted for the area you intend to inject.[8]
In summary, the assumption that "under the eyes are less at risk" is not supported by reliable sources. More conclusive data indicates that the most reported areas are the nose, forehead, and between the eyebrows.
Warning signs you should know: Severe pain, blurred vision, and more.
Symptoms of a blood clot may occur during or shortly after injection. The FDA recommends seeking immediate medical attention if you experience unusual pain, changes in vision, skin near the injection site turning white, gray, or blue, or any signs of a stroke.[8] The table below summarizes the symptoms observed in patients according to the study review.
| symptom | Proportions found in the review. | Observations |
|---|---|---|
| Reduced or blurred vision; dark or dim vision. | All patients in Kato's study had decreased vision, and 90.3% of 216 eyes examined showed initial visual acuity less than or equal to 20/200.[2] | Beleznay noted that common symptoms include sudden loss of vision and pain.[5] |
| Eye pain or unusual pain. | 38.4% (Kato)[2] and 31.2% (Doyon)[3] | Not all patients experienced pain. Therefore, the absence of pain does not mean it is safe. |
| Droopy eyelids | 56.4% (Kato)[2] and 56.2% (Doyon)[3] | The numbers represent the proportion of reported cases, not the probability of developing symptoms after vaccination. |
| Inability to move the eyeball (ophthalmoplegia) | 50.0% (Kato)[2] and 44.1% (Doyon)[3] | It is often accompanied by drooping eyelids or decreased vision. |
| Skin discoloration: pale white, dark purple, in a network pattern. | 73.2% (Doyon)[3] and 43.8% (Beleznay, 2019)[4] | DeLorenzi explained that pale skin, a purple mesh pattern, slow blood return to the skin, and a bluish-red discoloration may be observed, followed by blisters and tissue necrosis within a few days.[6] |
| Headache, nausea, vomiting. | Headache and nausea or vomiting with 12.0% (Kato).[2] | This could be a sign that other blood vessels are also affected. |
| Symptoms similar to a stroke. | 19.2% (Doyon)[3] And 16.2% has neurological symptoms (Kato).[2] | The FDA gives examples of symptoms such as sudden difficulty speaking, numbness or weakness in the face, arms, and legs, difficulty walking, facial paralysis, severe headache, dizziness, and confusion.[8] |
If this happens, what should you do? See a doctor and an ophthalmologist immediately.
The steps below are summarized from FDA guidelines and publicly available reviews. They are general knowledge. If symptoms are present, follow the advice of your attending physician.
- Instruct the patient to stop immediately if they experience pain, blurred vision, or changes in vision during the injection. Review work indicates that the procedure must be stopped immediately, and the FDA requires patients to stop the injection immediately if they observe pale skin, changes in vision, signs of a stroke, or unusual pain.[2][8]
- See a doctor immediately; don't wait to see. A review indicates that vision loss from fillers requires prompt referral to an ophthalmologist, and the FDA recommends seeking immediate treatment.[2][8]
- Please inform them about any recent filler injections, including the type, location, and time of injection. This information is necessary for the doctor to make treatment decisions. For example, if it's hyaluronic acid filler, the enzyme hyaluronidase is used to break down the substance.[2][6]
- If you experience symptoms similar to a stroke, such as difficulty speaking, facial asymmetry, or weakness in your arms or legs, treat it as an emergency.[8]
Timing is critical. Kato's review states that the goal of treatment is to restore blood flow to the eye as quickly as possible, claiming that after about 90 minutes, retinal damage may be irreversible. However, some research suggests that even 12–15 minutes can be severe. These figures are cited by the authors from other studies.[2]
It should also be understood that treatment does not guarantee outcomes. Kato noted that there is no standardized, evidence-based strategy yet.[2] Doyon's work found that the most commonly used treatments were subcutaneous hyaluronidase injections (70.1%), steroids (57.3%), and intravascular thrombolytic therapy (56.0%), but none were significantly associated with improved vision. Partial vision retention at the onset, however, was a better predictor of recovery.[3] And Beleznay concluded in 2019 that there is no single treatment that is consistently effective.[4] The sources available do not suggest any methods for doing this at home.
Does a cannula really reduce risk?
The original clinic article stated that cannulas (blunt needles) significantly reduce risk because they are more difficult to penetrate blood vessels than sharp needles.[1] Upon checking with accessible sources, it was found that cannula is indeed a recommended measure, but there is no source confirming that it eliminates the risk.
- Kato's work indicates that key review recommendations to reduce risk include choosing a blunt-tipped cannula to avoid puncturing blood vessels.[2] And the 2025 review identified blunt-tipped cannulas in high-risk areas as one of the risk reduction measures.[7]
- However, in Kato's study, only 23 patients were known to have used the same device for injection; 13 used needles and 10 (43.5%) used cannulas, meaning there were reports of patients experiencing vision loss after injection with a cannula.[2] There is too little data to compare the risks of a cannula to a needle.
- The same study found that injection devices with a larger diameter were associated with poorer visual outcomes, but this result was mixed with the type of substance injected, as autologous fat grafting used larger devices.[2]
In conclusion, it should not be assumed that using a cannula eliminates the risk. The review recommends a combination of measures, including:
- Inject in small amounts, using a moving needle or cannula, instead of releasing the substance in a single lump at one point.[2][7]
- Inject slowly, use low pressure, and aspirate before injection whenever possible.[2][7]
- The injection can be administered into the bone or into the superficial dermis because the subcutaneous layer often contains blood vessels.[2]
- Know the location and depth of blood vessels in the injection area, and have hyaluronidase ready in case of blood clots.[2][6][7]
These measures theoretically reduce risk, as recommended by experts, but the reviews I read were compilations of case reports and recommendations, not trials proving which methods eliminate risk.[2][7]
Before deciding to get under-eye fillers, what questions should you ask your doctor?
Safety depends on both the procedure itself and the availability of the clinic. The following questions, summarized from FDA guidelines and reviews, can be asked to any doctor, anywhere.
- Who should administer the injection? The FDA recommends choosing a licensed provider with experience in dermatology or cosmetic surgery, and viewing filler injections as a medical procedure, not just a typical cosmetic procedure.[8] Kato's work also found that the proportion of non-healthcare providers administering vaccines increased in later reports.[2]
- Is the product authentic and authorized? The FDA warns of counterfeit products on the market and advises users to check the packaging.[8]
- The FDA recommends discussing injection sites and the risks associated with each site before injection.[8]
- Does the clinic have a plan in place for cases of blood clots, such as having hyaluronidase readily available and a referral procedure to an ophthalmologist? The FDA and Kato state that patients should have such a plan in place beforehand.[2][8]
The clinic states that it prioritizes patient safety, uses cannula, and analyzes individual facial structures.[1] This information is from the clinic itself. Interested individuals should inquire about the details of the treatment plan directly with the doctor before making a decision.
For more information on the techniques and injection layers of under-eye fillers, see below. Under-eye fillers: A new technique to correct deep wrinkles and under-eye bags. And information about filler services at... Fresh Code Clinic's filler service page.
FAQ (Frequently Asked Questions)
Q: Is it true that you can go blind from injecting filler under the eyes?
Q: What are some warning signs after filler injection that require immediate medical attention?
Q: What should I do if I suspect a blood clot after filler injection?
Q: Is using a cannula safer than using a needle?
Q: Is the area under the eyes less at risk than the nose or between the eyebrows?
Q: What questions should I ask my doctor before getting under-eye filler injections?
Conclusion
Can under-eye fillers really cause blindness? According to available reviews, the answer is yes. Reviews classify it as an uncommon but serious condition, with no precise incidence known, and most patients do not regain vision afterward. The most commonly reported locations are the nose, forehead, and between the eyebrows. However, the sources do not confirm that under-eye fillers are low-risk, nor do they confirm that the cannula eliminates the risk. If you experience severe pain, blurred vision, drooping eyelids, or pale skin after injection, stop the procedure and consult a doctor or ophthalmologist immediately.
If you are interested in fillers, you should have your face assessed by a doctor and the risks associated with the injection site explained before making a decision. The information in this article is general knowledge and is not a diagnosis or guarantee of results. For more information, consult a doctor for an evaluation first.
References
- Is it true that getting filler injections under the eyes can lead to blindness? (Original article) — Fresh Code Clinic
- Visual loss after aesthetic facial filler injection: a literature review on an ophthalmologic issue — Arquivos Brasileiros de Oftalmologia
- Update on Blindness From Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases — Aesthetic Surgery Journal
- Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature — Aesthetic Surgery Journal
- Avoiding and Treating Blindness From Fillers: A Review of the World Literature — Dermatologic Surgery
- Complications of injectable fillers, part 2: vascular complications — Aesthetic Surgery Journal
- Anatomical-based filler injection techniques for the midcheek groove and infraorbital region: Narrative review — JPRAS Open
- Dermal Fillers (Soft Tissue Fillers) — US Food and Drug Administration
