What is infection after an eye injection?
Infection results from the introduction of bacteria into the eye after a needle penetrates the eye wall. It is called endophthalmitis. It is a very serious complication that requires urgent evaluation and management, as it threatens loss of vision and blindness. Eye injections are given for many reasons including wet macular degeneration, diabetic retinopathy, retinal vein occlusion, and uveitis.
What are the chances of getting an infection after injection?
A common response to this question is one in several thousand. This is the risk of infection after a single injection. However, in many diseases, injections are given repeatedly over time. This is an important issue because the risk of infection in a given patient over the course of multiple injections increases to as high as one in 200. This is a much higher risk than is usually quoted.
What factors affect the risk of infection?
There are many factors that affect the risk of infection. Patient-dependent risk factors include diminished immune response. This may be due advanced age, diabetes, AIDS, or medications. Other patient-dependent factors include poor eyelid hygiene and the tendency to rub the eye after injection, potentially introducing bacteria to the eye. Wearing make-up may increase the risk of endophthalmitis, because bacteria may reside in make-up. .
What precautions can the doctor take to reduce the risk of infection?
There may things a doctor does to reduce the risk of injection. Standard practice is to use Betadine or Chlorhexidine to reduce the amount of bacteria on and around the eye at the time of injection. Additional steps that may be taken include the use of an eyelid speculum to hold the eyelids open, especially if the patient cannot hold their lids still for the injection. The need for a speculum may be reduced by the use of a shielded needle, which isolates the edge of the lid from the needle in order to reduce bacterial contamination. Additional steps that may be considered optional include the use of sterile gloves, masking the face (patient and/or physician; in order to reduce contamination from the breath), and preparation of the eyelids with a Betadine swab. The use of antibiotic eye drops is controversial. Although intuitively, antibiotics might appear to be helpful, some feel they are unnecessary, and others feel they may increase the risk of infection.
Finally, the type of medication may affect the risk of infection. For example, there is a higher risk of endophthalmitis after injection of steroids compared to antiVEGF medications.
What can a patient do?
A patient can be a partner to reduce the risk of infection. Keeping healthy (diet, exercise, and adherence to medication schedules) will help maintain a strong immune system to help prevent infection. Eyelid hygiene helps to reduce the amount of bacteria that live on the eyelids. Avoiding the use of make-up may reduce bacterial contamination. Finally, it is important to avoid touching or rubbing the eyes after injection, as this may introduce bacteria to the eye.
If you do experience pain and/or loss of vision, especially after the first day of injection, it is important to notify your doctor. Early detection of infection is critical to avoiding permanent loss of vision.
By Scott E. Pautler, MD
Copyright © 2025 Designs Unlimited of Florida. All Rights Reserved.