EYE-CODE Protocol for the Nonophthalmologist for Treatment of Retinal Artery Occlusion After Intra-Arterial Injection of Soft-Tissue Fillers: 2025 Update.

BACKGROUND

Vision loss following a facial esthetic procedure with soft-tissue fillers is an event for which there is only a short treatment window to restore blood flow before irreversible ischemic damage occurs.

OBJECTIVE

To provide a current standardized treatment approach for the management of retinal artery occlusion after intra-arterial injection of soft-tissue fillers.

METHODS

This document provides an updated, simple, and evidence-based protocol for acute treatment in the office setting using the acronym EYE-CODE: EYE (I call retinal referral center), C (check vision and optic nerve function), O (ocular massage), D (decrease intraocular pressure), and E (erase filler).

RESULTS

The EYE-CODE protocol assists esthetic physicians to determine the extent of vision loss and provides an initial treatment strategy using medications likely to be available in most practices. This includes agents that reduce intraocular pressure, improve retinal perfusion, and potentially dissolve the filler embolus and any associated blood clots. Suggestions are also made for treatments that can be continued by an emergency ophthalmologist.

CONCLUSION

The EYE-CODE 2025 update provides physicians with a comprehensive reference for the management of retinal artery occlusion caused by soft-tissue filler injections.