Macular Society

Update on My take on stress free painless Injections

Had my 10th eyelea injection yesterday. After the preliminaries, eye test, scan, initial anaesthetic drops and iodine I went into the sterile room. For the first time ever, I was asked "Why are you here?" What??? I had to stop myself from laughing out loud. "By appointment and for an injection in my left eye," was my rather puzzled reply. Were they checking if I had all my marbles? I know I am getting on a bit and always go there alone by choice.

I then asked for extra anaesthetic drops and explained that on 7 out of nine occasions I had felt the sharp pain of the needle going in. The nurse said she always uses a full bottle but the doctor would give me extra ones if I asked him although he was right there.

I was given extra drops and at first it seemed to work until the very last split second when I still felt the sharp pain and my body reacted. Of course both, doctor and nurse, could not fail to notice it. Although I thought It was a slightly better experience than some I had in the past, it was not entirely satisfactory as there seemed to be something wrong with the clamp as some of the drops hit the lower eyelid rather than the eye. It may have had something to do with the fact that they were running late due to emergencies and I was the last patient of the day. That is one of the drawbacks when you get slotted in "as and when".

My question is, how can I stop my body from reacting so violently ? I'm not squeamish and generally down to earth and take things in my stride..

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You shouldn’t worry about your reaction they should be more compassionate they all should get at least 1 injection so they know what we go thru my prayers r with you

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I think the retinal specialists should have the betadine put in their eye and see how they react. They can forgo the injection because it seems betadine is the problem. It is for me and seems others report the same problem. Even with thorough rinsing about 4-7 hours post injection, I become sensitive to light and can hardly open my eye because it is so painful. I reside in the U.S. I have opted for the “heavy duty numbing drops” vs the injection. I wish Kaiser provided a small bottle of numbing drops that I received from Mercy facility when they referred me out while they were short specialists. Kaiser does not do it. Mercy makes small batches each day and you can use for 24 hours if needed for pain. It helped immensely.

Going on 2 years Started with Avastin then Eylea and now back with Avastin. I think my symptoms are worse with Avastin but my dr. disagrees. Also the gel when used is awful because it leaves hard residue that is very painful. I use drops but not suppose to rub eye and very difficult to remove. The injection feels like a lot of pressure but not painful just uncomfortable for me.

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Do you mean you have been given numbing drops to take home? I have never heard of that? Anyway, my question was, how to stop the injection itself from hurting and how to stop myself from reacting. Only on 2 out 10 occasions did I just feel the pressure, which is bearable. It is the sharp pain of the needle going in that makes me squirm. True, the soreness of the aftermath is always unpleasant and makes me feel quite miserable, say the least. I always go to bed with a couple of painkillers and after about 12 hours I usually feel better.

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I was given numbing drops to bring home when I was treated at another facility other than my HMO at Kaiser. You can use them up to 24 hours for pain then discard. I am sorry you have the reaction that you do with the squirming. Because of the pressure I feel, I tend to just push back into the headrest on the chair but then it is over. It is how our bodies react to the injections so I am not sure how you can quit squirming. You could try relaxation techniques like biofeedback. I tend to do that and it helps.

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Ah ayayay, so sorry you still felt it. Sounds like it didn't fully have time to work maybe. Did they inject a different part of the eye?

Not sure what you can do, your body's natural reaction to pain is to flinch from it. When it's happened to me I've tried to focus on tensing everything else to stay still, count in my head 321, grunt in pain to release the tension and I squeeze the hell out of the poor nurse's hand!

Hope you find a way through it x

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Thank you so much, eyesright. The injection was placed in the left quarter of my eye (about 9oclock?) They usually use the left or bottom. As for the flinch or jerk - it happens without warning and it comes and is gone in a split second. I do try to keep my head still, though how successful I am, I don't know. If the staff notice my momentary brief distress, and I know they do, wouldn't you think they make a note of it and try to make things better for me the next time? I suppose it is difficult when you have someone different almost each time.

Anyway, I feel ok now and, after all, I am talking about only a few seconds of distress. There are worse things in life. I hope to have a 2 moths rest from it now.

How are you doing? Are your implants still working?

Best wishes x

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Hi, no got oedema again. I'm due 3rd one next Tuesday. Today couldn't use computer at work even with giant screen. Hey ho. As you say, there are worse things in life. Reading between the lines next review with consultant will be a difficult conversation I think if this next implant doesn't work. I'm saving my energy in case I have to fight for further treatment.

Hope this inj does the trick for you x

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hope you get on ok eyesight- maybe they will agree to alternate with injections?

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Dear ayayay,

It may be advisable to report your concerns to your ophthalmologist via their secretary.

I am copying a link to our Pain following injections factsheet to use as a discussion point:

macularsociety.org/sites/de...

Please do not hesitate to contact us if we can be of any further help.

The Macular Society helpline is open 9am – 5pm Monday to Friday on 0300 3030 111.

Alternately, you can contact us via:

help@macularsociety.org

Kind regards,

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Thank you for that, Rosalyn. Hopefully I have another 2 months now before the next injection. Maybe I will take your advice to contact the consultant's secretary. Most of my concern was that the clamp did not seem to hold my eyelids I place properly.

Again, thank you.

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The pain you describe may be nerves within the sclera being in the line of the injection. Unfortunately we can not see them. I tend to get patients to breathe in and out and administer on inspiration as this helps prevent tensing. Also keep the other eye open, this prevents squeezing against the clamp which is painful. You could ask for sub conjunctival anaesthetic if the above doesn't help.

We are all different, no two eyes are the same.

Good luck

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Thank you so much for your informative reply. It is great to get advice from an injector. Is the sub conjunctival anaesthetic different from the usual drops and if so, should I have both types? Also, should I contact and ask my clinic for this in advance of the next injection?

As I said before, I am not a squeamish person and usually cope well with the stress, but there have been occasions when I felt I could not go back for another injection, though I always do.

Thank you again for taking the time to reply to me.

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You have anaesthetic drops then a small injection of anaesthetic under the clear conjunctiva. It makes the procdure longer but may work for you. There is the option of using tetracaine drops on a cotton bud and holding it on the area, it is toxic to the cornea so keeping it localised in this way may work for you.

All the best

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TY

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I always take a tranquilizer prior to the visit, and I practice breathing as I am in the chair to relax. The aide always holds my arm and reminds me to breathe if I'm not. I have often thought the drop did not go in the eye, but the MD can see where the drop went, and if I've said it didn't go in the tell me it did, I didn't feel it. I don't think you can feel it going in the eye, with all the other drops and wiping with the betadine they do.

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Thanks enopmar. True, I can't feel the drops going into my eye at that stage; I can only see the watery film appearing in my eye and I know then that the drops have gone in, but a couple of them definitely hit the lower lid, not just a surplus trickling out. I think the problem was the clamp which did not seem to keep my eye open properly. This has never happened before.

As for tranquilisers, I do not take any medication and do not keep any at home. Do you get them from your GP? I will try the breathing though. It may help.

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Hello ayayay

The matter of painful injections doesn't seem to be comprehended or adequately dealt with in the clinics. I've had over 20 injections now (both eyes) and each has been painful, most being extremely painful and at least one or two leaving me considering stopping (but not for long - think of the alternative!). I have done everything I possibly can: told the clinician, the nurses and injectors; I always ask for lots of anaesthesia and am given it and now take a codeine and two paracetamol prescribed by my GP about an hour before the procedure. And of course try breathing deeply when I remember and frantically clutching the nurse's hand.

This week I had to go to the clinic three times, a total of twelve hours in the car, with extended waiting due to emergencies and so on: we all know what that's like. The first visit was the usual injection and when I got home my vision had deteriorated; next morning the Mac Soc advised me to phone the clinic, who asked me to come in next day. While there I was seen by an (in my opinion) inexperienced doctor who, when I brought up the topic of my pain simply reiterated all the usual stuff I'd been doing all along. And when I said I'd done everything in my power she acted as if there was nothing she could do and I got the impression she wanted congratulations for making her superfluous suggestions and she had no more time to spend on me. I told her that all the official literature told us the injections should not be painful, but we'd just feel a little pressure. Huh! By that time the clinic was empty of patients and all but one nurse and one other, more senior, doctor, who then diagnosed a possible infection or inflammation. Which necessitated another visit next day as a day patient where inflammation was finally diagnosed. Google revealed this is uveitis and can become very serious. Does anyone know about this?

I'm 86 now and know I shall accept whatever happens but if painful injections can be avoided then that's what I'd prefer. Someone suggested asking the injector to move the site of the injection. Any views on that? Another MS member on here has tried putting in his dry eye drops frequently on the day he goes to the clinic. There are so many variables surrounding this whole topic - and we're all different, but I wish more effort were put into it by the powers-that-be. Anyway, good luck to you and to all of us while we struggle along with this condition.

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It's really a shame that you folks cannot see the same doc every time. I am in the US, my retinal specialist is the one who does the drops and the injection and I really trust him. If I had to have a different person do it every time I would be a lot more nervous than I am.

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Yes. Xanax. Benedryl also works very good as a tranquilizer and it's over the counter. There is an app called Insight, which is a meditation app. You can down it to your phone and do the relaxation meditations they work very well, show you how to breathe to relax. Good luck!

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Thank you for that, enopmar. Do those substances make you feel woozy? I have two short bus rides to get home from the clinic. I suppose I could get a taxi.

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Re being asked why you are there. The WHO "Guidelines for safe surgery" for any surgical or invasive treatment say that the patient should confirm their identity, and where possible what treatment they expect, and where on the body they expect it (i.e. left or right eye for us) before receiving treatment. Tests show that this saves a lot of problems, simple and obvious though it may seem. At the clinic I visit they make a bit of a game of it, to relieve the tedium, but it is always done! Perhaps your clinic is trying to start doing this? The current format of the guidelines is fairly new, and not universal yet But it should become part of the routine checklist of things that are done at a clinic visit.

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I have been getting injections for about 4 years before eyelea (I started end of dec 2017) shots were not fun but tolerable I had avastin and kenalog but these eyelea r kicking my butt the one I just had fri was the worst ever they did something new in beginning after putting iodine in they taped my eye closed this was before shot well u can bet I am asking them not to do that again and then they forgot to do the wash afterwards does that matter that much I just don’t know y they seemed to get a little better and now back to agonizing for about an hour aft then rest of day normal discomfort but tolerable any help would b appreciated

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I am puzzled. What do you mean by they taped your eye closed? How can they inject into a closed eye? The procedure at my hospital is that they cover my face with a sheet of gauze which is adhesive and sticks to the forehead and cheeks. Then they feel where my eye is and cut a slit into the gauze with scissors for the eye to be treated. I am always worried they may cut into my eye. Then the clamp goes on to keep the eye wide open.

They should always wash your eye afterwards; it is very important to get rid of the iodine, though in my experience, some injectors are more thorough than others. There will always be differences in the different injectors' methods. If you have any concerns you must really tell them. And no, it seems that it does not get any easier. The lucky ones just feel a pressure when the injection is being done, others feel the sharp pain of the needle going in. But I think that the soreness afterwards is common to all of us to a greater or lesser degree.

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Thank you for your help they had never taped my eye BEFORE an injection before but they put iodine in this time then taped shut I asked y they said to keep people from rubbing their eye which I have never done when the girl came in to give my injection she removed the tape went to put clamp in and said no her eye lashes r too long let’s use something else it looked like tweezers with sponges on the ends but it didn’t prick like clamps do so I thought ok and then they totally forgot to do heavy wash as prescribed by my dr

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