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Hashemi Eye Care - Neuroscience Institute and Research Center

Intravitreal Injection

A procedure to deliver medication directly into the eye, commonly used for macular degeneration, diabetic eye disease, and vein occlusions.

7 min read

Intravitreal injection is a procedure where medication is injected directly into the vitreous cavity—the gel-filled space inside the eye. This delivers drugs to the retina at high concentrations, treating conditions like macular degeneration, diabetic macular edema, and retinal vein occlusions. Millions of these injections are performed annually worldwide, making it one of the most common eye procedures.

Key Takeaways

  • Medication delivered directly into the eye
  • Treats macular degeneration, diabetic eye disease, vein occlusions
  • Quick procedure—typically under 5 minutes
  • Done in office—no operating room needed
  • Very safe when performed by experienced providers
  • May need repeated injections (monthly or as needed)

Medications Used

Anti-VEGF Agents (Most Common)

Block vascular endothelial growth factor (VEGF) to reduce abnormal blood vessel growth and leakage. See our anti-VEGF injections guide for detailed drug information, mechanisms, and outcomes.

Common Anti-VEGF Drugs:

  • Aflibercept (Eylea)
  • Ranibizumab (Lucentis)
  • Bevacizumab (Avastin)—off-label but widely used
  • Faricimab (Vabysmo)
  • Brolucizumab (Beovu)

Corticosteroids

Reduce inflammation and swelling:

  • Dexamethasone implant (Ozurdex)—slow-release pellet
  • Triamcinolone acetonide
  • Fluocinolone implant (Iluvien)

Other Medications

  • Antibiotics (for endophthalmitis)
  • Antivirals (for viral retinitis)
  • Ocriplasmin (Jetrea) (for vitreomacular traction)

Conditions Treated

Wet AMD:

  • Anti-VEGF injections are primary treatment
  • Dramatically improved outcomes
  • Converted previously blinding condition to manageable one

Diabetic Eye Disease

Retinal Vein Occlusions

Other Conditions

  • Myopic choroidal neovascularization
  • Uveitic macular edema
  • Radiation maculopathy
  • Some retinal infections

The Injection Procedure

Preparation

Before the injection:

  • Eye is numbed with anesthetic drops or gel
  • Antiseptic (povidone-iodine, betadine) applied to kill bacteria
  • Eyelid speculum placed to keep eye open
  • You look in a specific direction

During the Injection

  1. The needle is inserted through the white of the eye (sclera)
  2. Enters the vitreous cavity
  3. Medication is injected
  4. Needle is withdrawn
  5. Antiseptic reapplied

Total time: approximately 30 seconds to 2 minutes for the injection itself

What You'll Feel

  • Pressure sensation (most common)
  • Brief stinging from antiseptic
  • Some patients feel nothing
  • Rarely, brief sharp sensation

Most patients find the anticipation worse than the actual injection.

While the idea of an eye injection sounds frightening, most patients report minimal discomfort. The eye is thoroughly numbed, and the procedure is very quick.

After the Injection

Immediately After

  • Vision may be blurry (from numbing drops, antiseptic, or air bubbles)
  • Eye may be red where needle entered
  • May see floaters temporarily
  • Pressure sensation for a few hours is normal

First Few Days

Normal experiences:

  • Mild redness at injection site
  • Scratchy sensation
  • Floaters (especially small bubbles)
  • Slight discomfort

When to call your doctor:

Activity Restrictions

  • Most normal activities can resume immediately
  • Some doctors advise avoiding swimming for a day
  • Avoid rubbing the eye
  • Generally no other significant restrictions

Risks and Complications

Common (Usually Minor)

  • Subconjunctival hemorrhage (red spot on white of eye)—harmless, resolves
  • Floaters—usually temporary
  • Mild discomfort
  • Transient elevated eye pressure

Rare but Serious

Endophthalmitis (Infection Inside Eye):

  • Risk approximately 1 in 2,000 to 1 in 5,000 injections
  • Reduced by strict sterile technique
  • Requires emergency treatment
  • Can cause vision loss if delayed

Retinal Detachment:

  • Very rare
  • Symptoms: flashes, floaters, curtain over vision

Other Rare Complications:

  • Cataract (from needle touching lens)
  • Persistent elevated eye pressure
  • Bleeding inside eye
  • Stroke or heart attack (with anti-VEGF—very rare)

Treatment Schedules

Loading Phase

Many protocols start with monthly injections:

  • Build up drug levels in the eye
  • Gain control of the disease
  • Typically 3 or more monthly injections

Maintenance Phase

After initial control, various approaches:

Fixed Interval:

  • Injections at regular intervals (e.g., every 8 weeks)
  • Predictable but may over- or under-treat

Treat and Extend:

  • Gradually increase interval if stable
  • Decrease if disease recurs
  • Personalized approach

PRN (As Needed):

  • Inject only when disease recurs
  • Requires frequent monitoring visits
  • May result in worse outcomes than regular treatment

How Long?

  • Treatment is often ongoing (years)
  • Some patients achieve stability and can extend or stop
  • Others need continued injections
  • Depends on condition and individual response

What to Expect Over Time

Typical Journey

  1. Diagnosis: Condition requiring injection identified
  2. Loading phase: Monthly injections for 3+ months
  3. Assessment: Check response, adjust plan
  4. Maintenance: Ongoing treatment as needed
  5. Monitoring: Regular visits even if injections spaced out

Realistic Expectations

  • Most patients maintain or improve vision
  • Complete cure is uncommon—management is the goal
  • Treatment burden is real (frequent visits)
  • Benefits outweigh risks for most patients

Frequently Asked Questions

Does the injection hurt?

Most patients experience minimal discomfort—usually just pressure or a brief stinging. The eye is thoroughly numbed before the injection. Many patients say it's much better than they expected.

Will I see the needle?

You'll see a blur or shadow but won't see the needle clearly. Looking away as instructed keeps your vision directed away from the injection site.

How long does the injection take?

The actual injection takes seconds. The entire appointment, including preparation and post-injection check, typically takes 15-30 minutes.

How many injections will I need?

This varies widely by condition and individual response. Some patients need monthly injections for years; others can eventually extend to every few months. Your doctor will develop a personalized treatment plan.

Can I drive after the injection?

Most patients can drive after the effects of the dilating drops wear off (a few hours). Vision may be blurry initially from the drops and procedure. If in doubt, arrange transportation.

Why do I need injections so often?

The medications work locally in the eye and wear off over weeks. Regular injections maintain therapeutic drug levels. Researchers are developing longer-lasting treatments.

Are there alternatives to injections?

For most conditions treated with intravitreal injections, injections are the most effective option. Laser treatment may be an adjunct or alternative in some cases. Discuss options with your doctor.

What if I miss an injection?

Contact your doctor to reschedule as soon as possible. Missing injections can allow the disease to progress. If significant time has passed, your doctor may adjust the treatment plan.

Can both eyes be injected at the same visit?

Many doctors do inject both eyes in a single visit if both are being treated. Some prefer separate visits to reduce the (very small) risk of bilateral infection. Discuss the approach with your doctor.

References

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