Do Avastin Injections Hurt?

Do Avastin Injections Hurt?


Intraocular injections of Avastin usually do NOT hurt. Once in awhile, I have patients or readers of my blog who complain of severe pain following an intraocular injection.  Why?

It’s Not the Needle That Hurts

I believe the pain is due to the solution used to clean the eye prior to the injection and not the needle itself.

The solution is called “Betadine” and is commonly used to cleanse the eye prior to intraocular injection. Most retina specialists use this a part of their routine.

In a special few cases, these patients are not feeling pain from the needle, they are actually super-sensitive to the iodine prep. This prep is commonly used to clean the eye prior to the actual injection.

Usual Preparation for Injections

My preparation for the “procedure” is probably slightly different than your own doctor’s.

Upon arrival to the office, my patients have already been using antibiotic drops for the past four days. In theory, this limits the bacteria that builds up around the eye and may reduce the chance of infection from the injection.  This has never been proven.

At the office, we dilate the eye and start the numbing procedure. We use a cotton swab dipped in 4% lidocaine (numbing solution) and keep it pressed against the area of injection for about 20-30 minutes. We usually use 2-3 different swabs over the 20 minutes.

How to Keep the Eye Open

Using a spring like device, called a lid speculum, the eyelids are opened. You can not blink.

A drop of Betadine is placed on the eye at the injection site.

While looking “up,” the shot is given using a very short (27 gauge), but very sharp needle. I like to inject at the “6 o’clock” position just beneath the cornea.

After the needle is withdrawn, another drop of iodine solution (Betadine) is placed on the eye.  The eye is then rinsed.

Patients Who Have Pain

Patients who experience pain from the intraocular injection describe pain that last overnight.  Often, they don’t tell me about the horrible experience until the next visit.  This makes me believe that the discomfort is pretty steady for several hours.

To me, this is not injection pain.  Others describe the pain as an electric current.  Almost always the pain takes 12-18 hours to dissipate.  This can not be from a simple needle.  (Ever get an injection in the arm?).

How to Avoid Pain from Intraocular Injections

In patients in whom I suspect a “sensitivity” to Betadine, I’ll omit the iodine-based solution at the time of the next injection.  Almost always, this is the remedy!

Remember, this is my method of treatment and your own doctor may not agree.

What Does This Mean?

It took me several patients to realize that this was happening.  People didn’t complain often, but when they did, the complaints were emphatic.  I believed them.

The best part of this discovery is that…you shouldn’t fear the injections due to pain!  Too many people write in refusing additional injections due to the pain.

If you have experienced a painful intraocular injection, you might want to suggest this to your doctor.  This may be a simple solution to continue treatment to save your vision!


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  • Dick Marquis
    Posted at 12:31h, 31 May Reply

    DR. Wong,
    Are u familiar with the Newsweek (May 23) article on stem cell uses for vision problems and in particular, AMD? It appears there may be some hope for future use in humans to cure or at least reduce the effects of AMD.

  • J P Hickey
    Posted at 15:10h, 31 May Reply

    My wife was quite concerned before her first shot. She was pleased to feel absolutely no pain;

  • Peter R Adler
    Posted at 19:21h, 10 August Reply

    I’ve been treated for AMD with Avastin and, more recently, Eyelea injections. Each time, my doctor uses a prophylactic wash with 10% Betadine. I used to react badly to the Betadine, with intense pain lasting anything up to three days. A few months ago my doctor mentioned that people seem to react very differently; with some, there was severe pain, with others, hardly any. I came across an article on the possibility of a connection between iodine deficiency and skin sensitivity to iodine/iodide compounds. I didn’t know whether I had a deficiency but figured, What can it hurt? So I started to take 150mcg of iodine (kelp) a day, increasing to 450mcg in the two weeks prior to my treatments.
    The difference was dramatic. I now experience no more than a slight discomfort following my injections. It usually clears up within a couple of hours, with absolutely no after effects. When I told this to my doctor he was sceptical. He didn’t use the word ‘placebo’ but that’s what he seemed to be thinking. If this is a placebo effect, it’s one I would highly recommend!

    • Randall V. Wong, M.D.
      Posted at 10:32h, 17 August Reply

      Dear Peter,

      Thanks for sharing. Hadn’t heard of this possible mechanism, but have noted that a small percentage of my patients do have similar stories to yours.


  • Wendy Todd
    Posted at 22:46h, 20 October Reply

    Is there something I can ask to take or is there anything i can do to ease the pain after the injection? The pain is so intense nothing over the counter helps. I’m in pure hell for at least 12 hours. 🙁 The next morning my eye is so swollen it looks like I’ve been in a fight.
    My doctor acts like I’m crazy for saying I’m in pain bc according to him the injections don’t hurt. I’m thinking about switching doctors bc I need a caring doctor.

  • Pingback:Finding a Retina Specialist in Northern Virginia
    Posted at 11:42h, 21 March Reply

    […] Wendell and Dee are my assistants.  They’ve help me develop this method which keeps the eye injections painless. […]

  • Steve
    Posted at 19:03h, 12 February Reply

    Hi doctor, you are a good doctor I can tell I went through two retina operations and read and watched all the great stuff you’ve put on your pages and YouTube. It’s been almost six months since the last operation, teh retina is doing fine, but I have swelling in the retina still, and have gotten two injections of some steroid stuff along with predforte still the eye drops, and ketorolac still too…anyway, for the most part the injections for me have been pretty pain free, sme preparation, the q tip under the eyelid for a while, then the injection, I completely trust my opthalmologist, and so I’m never very worried, I think if you were my opthalmologist and surgeon I’d trust you just like him.

  • Vivian
    Posted at 01:18h, 13 July Reply

    Hi Doctor, so I got my first eye injection on Monday 7/9/18 the shot itself did not hurt. I did and have been experiencing pain in my eye really bad since. They did clean my eye with Betadine. I called them the next day (Tuesday) due to eye lids being swollen with mucous discharge and pain. I went in Wednesday I explained to him that my eye sight seems like it’s more of a 3D type of vision and they just checked my eye and blamed the Betadine that was it. I feel like I’m cross eyed and its very unnerving because now I can’t drive. I have had CSR for 9 months now and for the past week I feel like I’m going crazy because I don’t know how to explain to the eye doctor how I’ve been feeling since Monday.

    • Randall Wong, M.D.
      Posted at 11:09h, 23 September Reply

      I hope this finds you well. I apologize for the extreme delay. Some of my patients do have issues with Betadine. Hope your CSR was helped! Randy

  • herman48
    Posted at 16:51h, 12 December Reply

    I had an intraocular injection of Avastin last Monday, in my left eye. The injection itself was painless, but my eye hurt until the next Wednesday night/Thursday morning. The pain was strong but not unbearable. It hurt the most when I rotated my eyes, and the pain seemed to come from the back of the eye and spread to my left frontal sinus. I don’t think it was caused by the Betadine, because there was little or no pain unless I rotated my eyes. I was not given any antibiotics before or after the procedure, but the doctor prescribed a nepafenac 0.3% solution (Ilevro), one drop a day. I used it but it gave me no relief. Fearing an infection but without consulting my doctor I also used another solution containing Neomycin, Polymyxin B Sulfates and Dexamethasone (left over from when my wife had her cataract surgery) and this did give some temporary relief.
    I will have Avastin injected in my right eye this coming Monday, and I hope that I won’t have the same side effects, which I will describe to my doctor before the procedure. I am quite sure that these first injection won’t be the last (I have diabetic retinopathy and macular edemas). Anyhow, it may be a placebo effect, but I think my vision has improved some after the injection: the deformation of the lines on the grid appears to be less pronounced.

    • Randall Wong, M.D.
      Posted at 20:59h, 16 December Reply

      Tough to advise you over the Internet, but please inform your doctor. As you’ve read, Betadine sensitivity can cause discomfort/pain, but I’ll reserve that conversation for you and your eye doctor. Randy

  • Martha38
    Posted at 18:06h, 03 November Reply

    All of the doctors insist on using betadine as they say it is the safest thing available. While you are correct re the sensitivity and discomfort there doesn’t seem much that patients can do about it.

    Isn’t there something that come be taken ahead of time to reduce the allergic reaction to it?

    This site is probably closed by now. However it is still an ongoing problem.

    • Mike Rosco
      Posted at 20:11h, 03 March Reply

      Hey Martha,

      Betadine is an antiseptic solution that is often used to disinfect the eye before an intraocular injection. The sensitivity to betadine can vary among individuals, and in some cases, it can cause discomfort or irritation during the procedure.

      In addition to anesthetic eye drops, there are a few things that can be done to reduce the sensitivity to betadine during an intraocular injection:

      1. Ask your doctor about using a milder antiseptic solution: Some doctors may be willing to use a milder antiseptic solution, such as chlorhexidine, instead of betadine if you are particularly sensitive to it.

      2. Discuss the use of a steroid eye drop with your doctor: Steroid eye drops can help to reduce inflammation and swelling in the eye, which can make it less sensitive to betadine.

      3. Use cold compresses: Applying a cold compress to your eye before the injection can help to reduce sensitivity and discomfort. You can use a cold pack or a wet washcloth that has been chilled in the refrigerator.

      Your doctor may have additional suggestions or accommodations they can make to help you feel more comfortable during the procedure.

      Hope this gives you a few ideas,a

      Mike Rosco, MD

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