Single-Center Retrospective Case Series of 33 Patients with Ophthalmic–Cerebral Embolic Stroke Following Cosmetic Facial Injection, 2017–2025

Background/Objectives: We aimed to describe clinical phenotypes, imaging distribution, treatment time window, and short-term outcomes of ophthalmic–cerebral artery embolic stroke caused by cosmetic facial injections or fillers in a tertiary neurology-referred cohort. Methods: This single-center retrospective observational case series included 33 consecutive eligible patients with ophthalmic artery embolism complicated by cerebral infarction or optic nerve ischemia after cosmetic facial injections. All 33 patients had cerebral infarction. Demographic, clinical, imaging, treatment-timing, and discharge-outcome data were extracted from medical records and analyzed descriptively. Results: Mean age was 31.1 ± 7.5 years (median 30.0, IQR 25.0–37.0); 29 (87.9%) were female. The injected materials were as follows: hyaluronic acid (24, 72.7%), autologous fat (8, 24.2%), and unknown (1, 3.0%). Anterior circulation involvement occurred in 32 patients (97.0%), posterior in 16 (48.5%) (an exploratory observation of uncertain mechanism; 15/16 co-occurred with anterior involvement), both in 15 (45.5%), multifocal/multi-territorial infarction in 24 (72.7%), and hemorrhagic transformation in six (18.2%). Optic nerve ischemia co-occurred in 25/33 patients (75.8%); no patient had isolated optic nerve ischemia without cerebral infarction. Median time from onset to intervention was 25.4 h (IQR 9.0–34.5); only two of 28 (7.1%) received intervention within 6 h. Within our cohort, earlier intervention was not associated with visual improvement (≤24 h 3/10 vs. >24 h 2/14; Fisher’s p = 0.61). At discharge, as a within-patient change between admission and discharge (not a controlled treatment-effect estimate), ocular motility abnormalities improved (17/26, 65.4%, p < 0.001), skin abnormalities improved (17/27, 63.0%, p < 0.001), and severe visual impairment improved (6/29, 20.7%, p = 0.031). Conclusions: Cosmetic facial injection/filler-related stroke is a specific type of iatrogenic embolic stroke caused by the dissemination of exogenous materials through facial–orbital–intracranial anastomotic pathways. Because the cohort was ascertained through a tertiary neurology department, the phenotype reflects the severe, brain-involved end of the spectrum and the distribution estimates are not generalizable to the full spectrum of filler-related vascular events. For patients presenting with acute blindness accompanied by skin ischemia, ocular muscle abnormalities, or neurological symptoms following cosmetic injections, early referral to both the stroke green channel and emergency ophthalmology for multidisciplinary evaluation is recommended, primarily to limit cutaneous necrosis, support extraocular muscle recovery, and monitor and control infarct progression and hemorrhagic transformation rather than to restore vision.