Intravitreal Injections and Endophthalmitis

Stephen J. Kim, MD


Int Ophthalmol Clin. 2015;55(2):1-10. 

In This Article

Aseptic Technique

Although strict aseptic technique has been advocated to reduce infection risk, conclusive data supporting its effectiveness are lacking. Handling of the syringe and needle can be consistently accomplished in a manner which avoids contamination by the hand or finger tip, which obviates the need, inconvenience, and extra cost for sterile gloves. Moreover, while routine insertion of a lid speculum is reasonable to avoid contamination of the needle tip, the lid margin and lashes can be safely avoided without a speculum in patients who comply with instructions (Fig. 2). A survey of members of the American Society of Retina Specialists in 2014 revealed that only 13% of members in the United States use a speculum routinely and that the majority of members (65%) use a speculum only in a minority of cases (<25%). Excessive manipulation of the lid margin should also be avoided to limit expression of bacteria-laden secretions from the meibomian glands, which may in turn increase contamination of the ocular surface. Aggressive treatment of blepharitis may therefore be beneficial in select patients.

Figure 2.

Intravitreal injection with subconjunctival lidocaine for anesthesia. Note the absence of a lid speculum in a patient who can comply with instruction.