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After the needle is withdrawn, another drop of iodine solution (Betadine) is placed on the eye.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!
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
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