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Eye Injections - What to Expect

You want to do WHAT, Doc?!?!?  Stab a needle in my eyeball?!?!  Are you out of your mind?!?  No way, no how, Doc!  I want a second opinion!

Yeah, that was my first reaction too.  I was more fatalistic, though, I think.  It didn't stop me from having a panic attack the first time I faced that needle.  I am not prone to panic attacks, mind you.  Which makes them... memorable.

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I have been near-sighted and had astigmatism most of my life.  It is only in recent years that I also developed Macular Edema and Diabetic Retinopathy.  It is for the edema that I got the needle.  I have been treated with an experimental drug called Eylea for the last 2-3 years.  Finally, I show improvement.  But it has not been pleasant.

Macular Edema is not the same as Macular Degeneration.  The edema causes the retina surrounding the optic nerve connection to swell with fluid.  I thought they had turned off half the lights.  Everything darkens and blurs.  I went shopping using both a flashlight and a magnifying glass because I could barely see the labels on the shelves.  There was no way I could read them from my height.  I avoided night driving because I could barely make out the lane lines.

So... I got the bad news.  Got the approval from my insurance provider.  Got the appointment.  Showed up on time.  Went through the preparations and was called into a room.  Sat in the chair, alone, calm, waiting for The Doc to come and conduct his torture.  The nurse assistant entered and I commenced my meltdown.

After copious wads of facial tissue, I got my act together.  The nurse assistant finished the preparations and the doctor appeared soon thereafter.

What happened, step by step...

Upon my arrival, both of my eyes were dilated.  They wanted to see if there was any change, positive or negative, since the exam when the decision was made.  Before the drops had taken full effect, I did the eye chart test and had photos taken by a machine on a rolling table.  This particular machine measured the thickness of the retina.

I moved to a seating area to wait for my eyes to reach full dilation.  I was called to an exam room.  A nurse assistant put drops into my eye.  These were the first of three drops.  I was never clear what the drops were.  I was told one or two were numbing agents, and one or two were antibiotics to prevent infection.  One of the drops caused a slight burning sensation.

The numbing drops worked fast.  The last application was a numbing gel, applied with a soft applicator.  I was told to keep my eyes closed.  The gel would work faster and more effectively if I did not keep opening my eyes.

Btw, if both your eyes need this treatment, you can elect to get both done on the same visit or separately.  I speak from experience.  Go with one at a time.

I sat in the chair locked in my own mind, my dread increasing.  I could not surf my cell or read a book.  Had I thought ahead I would have set up something to listen to.  Hindsight, as they say, is always 20/20.

Finally, the doc and a slew of nurse assistants crowded into the room.  The doctor made small talk while he viewed the images just taken and my records.  He confirmed which eye he was to treat that visit.  Then he separated my eyelids and installed a device to hold my eyelids open.  Remember the gel?  Well, my eyelids were glued together, so his help was definitely necessary.

He took an applicator and ran it over the surface of my eye.  I think he added some fluid but he might have been testing to make sure the eye surface was fully numb.  I was told to look up and off to one side, exposing the lowest area of the eye below the cornea.  Although blurry, I could see his shape and his hand approaching.

I felt an instant of pressure and pain.  Let me make this clear to you.  The pain did not come from the insertion of the needle.  The numbing substances ensure you never feel the needle.  The pain came from the hard jab.  The impact to the eye caused an immediate low grade headache.

The doctor updated my records and made more small talk.  We discussed his treatment plans for me.  He told me when he wanted to see me next, then left for another patient.  The nurse assistants were flushing my eye thoroughly to dissipate the gel and enable me to see again.  I was offered some drops to use over the next 24 hours for pain management.  I took them.

I texted my driver that I was done.  I made my appointment at the receptionists' desk and took the appointment card.  (I would have to wait until I could see again to add the appointment to the calendar on my cell.)  I grabbed a small plastic sunglasses insert and went outside to wait from my ride.  Arriving home, I went straight to bed.  There wasn't anything I could do until I recovered from the dilation.  And I had a headache.

I've had a treatment every two months for about two or three years now.  I've always been slow to heal, maybe due to Diabetes, maybe some other reason.  But I've finally shown enough improvement my next visit will not include an injection.

Are you thinking, wow, that fast?  Are you sure?  Yes.  We can not hold our eyeballs still.  Try it.  Not even when sleeping or trying to go to sleep can you stop your eyeballs from moving minutely.  So the injection HAS to be fast.  Hence the hard jab.  

What about infection?

Infection of the puncture wound or the eyeball is not likely, due to the antibiotic drops applied before you are given the shot.  However, other types of infection are possible.  Less than a week after one injection, I developed an infection in the tear duct of my treated eye.  I saw an urgent care physician and took a course of antibiotics.  The tissue below my eye swelled up and pus oozed from my ducts.  Applying pressure was awkward - I used Q-tips moistened with saline solution so as not to apply pressure to, or aggravate, the eyeball.  Trying to get a grip between two wet Q-tips to squeeze pus out was hard.  It took several weeks for the infection to disappear.  Today, nearly two years later, there is no disfigurement, although I am no beauty. :)

Tear Duct Infection 12/28/2014 Image1Tear Duct Infection 12/28/2014 Image1
Tear Duct Infection Image2 Days laterTear Duct Infection Image2 Days later
Tear Duct Infection Image3 Almost healedTear Duct Infection Image3 Almost healed
21 months later 9/18/2016 Image421 months later 9/18/2016 Image4

So, what are my tips?

  • Stock up on some saline solution ahead of time.

Although drops will be offered to you, occasionally the doctors' office will run out.  You can save them for months in the fridge, but that doesn't ensure a pure product.  If those drops burn, throw them out.  Better to have a couple unopened bottles of saline solution handy before you need them.

DO NOT use tap water, distilled water, or any other kind of water that is not commercially sterilized for use on the eyes.  Infection from non-sterilized fluid is all too likely.  

  • Schedule your appointment late in the day.

That way you can go home to bed when you are done.  If you schedule in the morning, and then go to work, answering phones is about all you will be good for.  And your customer service skills will likely be abysmal, between your aching eyeball, headache, and craving for a bed. 

  • Arrange for transportation.  

You won't be able to drive well when you leave.  I live a 40-minute walk from one of my retinal specialist's two offices.  I have walked all the way to and back, more than once.  When I do, I take a backpack with two bottles of water, a hat, and a cane.  I usually take more than 40 minutes to get home.  Not counting the stop I make at McDonald's on the way home (grin).

I had some of my treatments downtown, miles from home, and took public transit there and back again.  I had to ask other passengers which bus lines were approaching.  I felt naked, vulnerable, unable to perceive threats.  One occasion was close to sunset.  Between the sunglasses, dilation, and the setting sun, I felt blind and nervous.  It is always better if someone else drives you.

  • Pain relievers take 15 minutes for full effectiveness.  

Pop a dose upon your arrival at the doctor's office.  Don't wait until your headache starts.

  • Set up a text message on your cell to send to your driver as soon as you are done.  

Then set up something to listen to while your eyelids are glued shut.  Music, an audiobook, a podcast, anything to distract you from negative thoughts.

  • Don't plan any activities away from home for at least 24 hours.  

No shopping, no parties, no housework, no cooking.  You will barely be able to walk the dogs.  If TV shows will be on that you don't want to miss, tape them.  You won't be interested in anything but resting, with that headache and achy, itchy eyeball.  

Why itchy?  The injection point will develop a small scab.  The rubbing of that scab on the inside of your bottom eyelid will itch.  Time to take those drops you brought home or some saline solution.  

Getting eye injections will not kill you.  Yes, it is unpleasant.  Believe it or not, I've had worse.  Before the injections, I had a battery of tests to try to determine the cause of the edema.  They wanted to rule out a brain tumor pressing on the optic nerve.  So I had a spinal tap.  With just a local anesthetic.

Later it occurred to me why my spinal tap appointment was scheduled at the end of the workday.  It was so there were less staff and no patients to hear my screams.  They say that passing kidney stones hurt as much as giving birth.  Well, spinal taps hurt WORSE!  (IMHO, of course, since I have never passed a kidney stone.)

But that is a topic for another page:)

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