Impact of ocular pressure on pain scores during intravitreal injections with topical anesthetic applications

Objectives: Intravitreal injection (IVI) is a common outpatient procedure used to deliver medication into the vitreous cavity for the management of several ocular diseases. Minimizing pain and discomfort during the procedure is crucial for patient compliance, and also to avoid associated complications. This study aimed to compare patient pain experience during IVI under topical anesthetic, with and without exertion of ocular pressure to the injection site. Methods: In this prospective comparative study, patients who required frequent IVI for different retinal diseases were recruited and allocated to receive the injections with two different anesthetic methods on two occasions, in randomized order. One of the anesthetic methods involved applying manual pressure at the site of injection using a cotton swab soaked with topical anesthetic drops, and the other method utilized topical anesthetic drops alone. Following each IVI, the Visual Analog Scale (VAS) was used to score pain experienced by the patient during the procedure. Complications were recorded in each anesthetic method. Results: A total of 20 patients were enrolled in the study. Mean VAS pain scores during topical anesthesia with and without ocular pressure were 1.90 ± 0.72 and 2.30 ± 0.92, respectively. These scores were not significantly different ( P = 0.134). However, the incidence of subconjunctival hemorrhage was significantly lower after the ocular pressure method ( P = 0.006). Conclusion: The study showed that applying ocular pressure with topical anesthetic drops during IVI resulted in a lower pain score than using topical anesthetic drops alone. However, this result was not statistically significant. Moreover, the rate of subconjunctival hemorrhage was significantly lower when utilizing ocular pressure compared to the use of anesthetic drops alone, potentially enhancing patient comfort and adherence to the treatment.