25 Nov Shot in the Eye: Safe and…..Painless
Intraocular injections are given all the time. They don’t hurt. Intraocular injections of anti-VEGF medications (e.g. Avastin®, Lucentis ®and Macugen®) are given for the treatment of macular degeneration and also, sometimes, diabetic retinopathy.
A retinal specialist sees a variety of patients with retina disease, but most of the patients have either macular degeneration or diabetic retinopathy. The amount of injections given will continue to rise.
When I first recommend an intraocular injection for treatment, the apprehension is palpable. When I describe the process, the biggest question is really regarding pain and discomfort. A needle in the eye?
I almost never inject the same day I may recommend an injection; regardless of cause. I think patients need time to digest the reasons for the intraocular injection and to get comfortable about having a needle injected into their eye.
Infection is a risk. The risk is small, but the effects could be devastating. The the rate of intraocular infection is somewhere around 1:2000. This is comparable to cataract surgery. Prior to anticipated injection, I like patients to receive antibiotic drops 4x a day starting 4 days prior to the injection. We are not sure if this really is effective. Some docs will inject at the same day. It’s not malpractice.
Other possible complications include bleeding, cataract and retinal detachment (very unlikely).
Upon arrival to the office. Visual acuity and intraocular pressure are documented. The eye is dilated. We use cotton-tipped applicators dipped in Lidocaine (numbing solution) to numb the eye for about 15-20 minutes.
Remember, infection is a risk. We place a couple of drops of a povidone-iodine solution (Betadine®) on the eye to act as a microbicide (i.e. kills germs). This, in theory, should further reduce the risk of infection. This is the exact same preparation we use before intraocular surgery.
“Wow” That Didn’t Hurt!
The actual injection is anti-climatic. A wire speculum is placed to keep the lids open. The Betadine® is used again. The injection is delivered straight into the eye (a small, but very sharp needle is key). Done!
Instructions are given to continue antibiotic drops for 4 more days and to call if there is any loss of vision or pain (common signs of infection).
What Does This Mean?
Over time, more and more injections will be delivered for the treatment of macular degeneration and diabetic retinopathy. Intraocular injections have become favorable as it directly delivers the needed medication to the target tissue. In addition, there are several sustained release drug delivery systems; Ozurdex® and Iluvien® are great examples. These will be delivered as “injections” as well.
Remember: No pain.