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Injections into the Eye

An injection into the eye (an intravitreal injection) is the standard treatment for several conditions of the macula, and one of the most common procedures in medicine. The idea is alarming to nearly everyone beforehand. In practice the eye is numbed, the injection takes a few seconds, and most people say it was far easier than they expected. These injections have saved the sight of millions of people.

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What they treat

In each of these, leaky or abnormal blood vessels damage the macula. The medicines used, called anti-VEGF drugs (such as bevacizumab, ranibizumab, aflibercept and faricimab), block the signal that makes vessels leak and grow. Steroids are sometimes used instead. A drop on the surface cannot reach the retina in a useful amount, which is why the medicine is placed inside the eye.

The visit

  1. Your vision is checked, and usually the macula is scanned (OCT) to see how it has responded.
  2. Numbing. Drops or gel numb the surface. Some doctors add a small numbing injection under the surface.
  3. Antiseptic. The eye and lids are cleaned with iodine solution. This is the most important step for preventing infection. It can sting.
  4. A small holder keeps the lids apart, so you do not need to worry about blinking.
  5. The injection. You are asked to look in one direction, and the medicine is injected through the white of the eye with a very fine needle. It takes a few seconds. Most people feel pressure or a brief pinch.
  6. The eye is rinsed. Your vision or pressure may be checked before you leave.

The whole appointment takes longer than the injection: allow an hour or two. Bring a driver if you can, at least the first time.

Afterward

  • A scratchy, sore or watery eye for the rest of the day is common, mostly from the antiseptic. Artificial tears help. It should be better by the next morning.
  • A red patch on the white of the eye where the needle went in is harmless and fades in a week or two.
  • Floaters or small round bubbles low in your vision can appear for a day or two.
  • Do not rub the eye. Avoid swimming and eye makeup for a couple of days.
  • You can otherwise carry on as normal.

Call the same day if, in the days after an injection, you have increasing pain, worsening redness, a drop in vision, or marked light sensitivity. These can be signs of an infection inside the eye, which is rare but must be treated at once. See When to Call the Same Day.

Risks

Serious problems are uncommon.

  • Infection inside the eye (endophthalmitis): roughly one in a few thousand injections. This is the reason for the warning signs above.
  • A rise in eye pressure for a short time after the injection. This matters more if you have glaucoma; tell your retina specialist, and keep using your glaucoma drops.
  • Inflammation, bleeding in the eye, or a retinal tear or detachment, all rare.
  • Cataract progressing, particularly with steroid injections.

How often

The medicine is used up over one to several months, so the effect wears off. Treatment usually starts with injections about once a month. The gap is then lengthened step by step for as long as the macula stays dry, and shortened again if fluid returns. Newer medicines last longer in some eyes. Many people need treatment for years.

Missing visits is the main reason people lose vision during treatment. If you cannot make an appointment, rebook it promptly.

Questions worth asking

  • Which medicine are you using, and why that one?
  • How will we know whether it is working?
  • How often will I need injections, and for how long?
  • Who do I call after hours if the eye becomes painful?