Posterior Segment
Post-Intravitreal Injection Complications
Also known as: post intravitreal injection complications, post-injection complications, anti-VEGF injection complication, post injection pain, intravitreal injection red eye, post intravitreal injection, pain after eye injection, floaters after injection
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Symptoms after intravitreal injection range from expected irritation or subconjunctival haemorrhage to sight-threatening endophthalmitis, IOP spike, corneal abrasion, vitreous haemorrhage, retinal tear, or retinal detachment. The workflow is to separate mild improving irritation from worsening pain, increasing redness, reduced vision, floaters, hypopyon/vitritis, pressure symptoms, or retinal detachment symptoms requiring same-day emergency contact with the injecting ophthalmologist/retina service or ED.
Recognition
Symptoms: what patients report
- Mild gritty irritation or surface scratchiness can occur after injection and should improve.
- Subconjunctival haemorrhage may look dramatic but is usually painless with stable vision.
- Worsening pain, increasing redness, photophobia, or reduced vision is high-risk.
- New or worsening floaters, haze, curtain/shadow, flashes, or field loss suggests posterior segment complication.
- Severe headache, halos, nausea, or brow ache may indicate an IOP spike or another urgent pressure problem.
Signs: what the examination shows
- Expected findings can include subconjunctival haemorrhage with quiet cornea/anterior chamber and stable vision.
- Corneal staining or abrasion can occur after speculum/anaesthetic/iodine exposure.
- Hypopyon, vitritis, marked AC reaction, worsening injection, or reduced vision is managed as endophthalmitis on suspicion.
- Raised IOP, corneal oedema, or pressure symptoms require urgent review.
- Vitreous haemorrhage, retinal tear, or retinal detachment signs may be present if new floaters/field symptoms occur.
What OptoGuide™ covers for post-intravitreal injection complications
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Intravitreal Injections — EyeWiki
- Preventive factors, diagnosis, and management of injection-related endophthalmitis: a literature review. Singh R, Davoudi S, Ness S. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Arc
- Vitreous Inflammation Associated with Intravitreal Anti‐VEGF Pharmacotherapy. Agrawal S, Joshi M, Christoforidis JB. Mediators of Inflammation. 2013;2013:943409.
- Safety and Efficacy of Anti-Vascular Endothelial Growth Factor Therapies for Neovascular Age-Related Macular Degeneration: A Report by the American Academy of Ophthalmology. Bakri SJ, Thorne JE, Ho AC, et al. Ophthalmolo
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.