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(Ophthalmologist): To any future HN reader scared by those intraocular injections: don't fear them. I'm on my way to the operating room and going to perform cat

by gdebel 5y ago

(Ophthalmologist): To any future HN reader scared by those intraocular injections: don't fear them. I'm on my way to the operating room and going to perform cataract surgery under topical (=eyedrops only) anesthesia, as I always do, and as most surgeons today do. Patients won't feel anything except water slightly flowing on the eye surface. The surgical knife is 2.2mm wide : the 25 Gauge needle is 0.260mm wide. Anesthetic eyedrop work amazingly. Patients can actually feel the eye speculum (pro tip: open wide both eyes++, it will be less disturbing) and the itchy feeling of Betadine, and the touch of the needle : that's usually all. Don't postpone eye injections because of fear: if it is indicated, there is usually some degree of emergency.

jmnicolas 5y ago
Counter point: a few years ago my mother had a botched cataract surgery, she now sees worse than before. Don't act like you don't take a chance on every medical procedure. Most of the times it's OK, but sometimes it's not. Then what?
s1artibartfast 5y ago
A couple questions: How are you using the surgical knife in your intravitreal injection procedure? Any thoughts on how often patients can see the needle? I always thought it was out of the visual axis, but some reports in this thread mention seeing it !?
- randcraw 5y ago
  I've had eye injections three times now and never saw the needle. I can't imagine you you could, since the eye can't focus on the needle since it's inside the lens which is necessary to focus what you see outside the eye onto the retina. I don't see how the fovea could receive a focused image of the needle without help from the lens.
coffeefuel 5y ago
I was born with cataracts and had the natural lenses in my eyes removed when I was days old. Fast forward to 2018 and I had intraocular lens implants (I believe it's called) under general anaesthetic. Went fine for the most part, however I had to go to A&E because the pressure in one of my eyes was ~65. The cause was blood leaking into the back of one of my eyes (if I remember correctly), and they had to use the drops you mentioned. At the time I was a bit concerned with what they were going to do, but obviously was willing to have whatever done to get back to normal. I'm still impressed by how well those drops worked. And, yeah. All I could see was red (blood), and all I felt was just a prick of something sharp. Was done within probably 10-15 minutes.
sdenton4 5y ago
My fun fun eye surgery was to remove a stye that had hardened into a chalazion. This didn't involve any actual needle/scalpel work on the eye itself, but did require flipping my eyelid inside-out and cutting into the back with a scalpel. The local anaesthetic worked great. A side effect of the eyelid-flip (I think) was that my eye rolled into a position that wasn't seeing anything. Overall, it was kinda like going to the dentist, but I could keep chatting with the doctor through the whole thing. The ability to keep communicating was great for keeping things chill. (However, one must be careful not to laugh while there's a scalpel near one's eye.)
- metabagel 5y ago
  I used to experience blepharitis and occasional sties, but of all things what cleared everything up was tea tree shampoo and face wash with tea tree oil. https://www.healthline.com/health/eyelash-mites https://www.healthline.com/health/eyelash-mites Keep any tea tree oil product well away from the eyelashes. It's not actually necessary to treat it there, and you'll regret it if you get any of the product in your eyes.
  - sdenton4 5y ago
    Mine was caused by doing stressful grad school things, keeping ridiculously bad sleep schedules, and staring at a too-bright monitor for dozens of hours per day. These added up to rubbing my eyes a lot, which led directly to styes. After reducing my monitor brightness, the problem went away.
- ignoramous 5y ago
  Had that one myself. Looks way scarier in the videos: https://www.youtube-nocookie.com/embed/phWKZTsy2dg https://www.youtube-nocookie.com/embed/phWKZTsy2dg In reality, it is a not a big deal at all.
- CallMeJim 5y ago
  I had the same procedure on a lower eyelid, but the stye made the eyelid too thick to flip. An attendant had to force the eyelid down while the stye was lanced with a scalpel. For some reason, the anaesthetic didn't take effect. Pain.
cortesoft 5y ago
You can't tell me not to fear it. I have a HUGE eye phobia; I can't even open my eyes under water. It doesn't matter what anyone says, it isn't a rational thing.
- rblatz 5y ago
  This is so bizarre to me, to be an adult and just unable to control your own body? I guess I'm lucky to not have this issue, but man it's so foreign to me that you can't even open your eyes under water.
  - burnished 5y ago
    Would you also not struggle to touch a hot stove? I think it is a similar feeling. Genuine question too - I've got a friend who is comedically brave and doesn't experience pain the way that other people do who might express a similar idea. He just already knows that its unusual and not the default.
    - rblatz 5y ago
      That’s an interesting idea. I think I’d be able to touch it, I know I’d dislike it immensely though. But this question helped me clarify my thoughts around this more. It’s the distinction between rational fear vs irrational fear. Assuming clean water the fear of opening your eyes underwater is irrational, it’s not going to hurt you or do any long term damage. The example from the story about getting an injection on your eye is maybe someplace in between, needle in the eye is much more invasive, but also deemed medically necessary where the risk of not doing it is greater than the risk of doing it. Not having the ability to override your own emotions in cases where they are irrational is interesting to me. It’s like giving agency to an “external other” that you have no control over.
      - doliveira 5y ago
        I seriously doubt you can rationally override your own emotions at any situation. And you should doubt that too, it can make you biased to think you're being rational without noticing you're not.
closetohome 5y ago
Thanks, I'd never really thought about eye surgery before and now am deathly afraid of literally every aspect of it.
axegon_ 5y ago
Thanks for this! Mind you, as much as I understand the importance and need of such procedures, that doesn't make me any less terrified. I've had all sorts of absurd injuries over the years all over my body and I am in no ways frightened or disguised of any bodily fluids. That said, I am terrified of the idea of such a procedure. Same with dental work - I abhor the feeling of anything being done to my teeth. Getting a wisdom tooth pulled out was arguably the most terrifying thing I've ever experienced. A needle going into my eyeball wouldn't feel any less terrifying.
joshlemer 5y ago
What happens if a patient accidentally looks left or right during the surgery? I would be afraid of subconsciously/accidentally looking one way or an other during the surgery, but would that not cause a catastrophe?
- sedatk 5y ago
  We call those happy little accidents.
- iKnowKungFoo 5y ago
  I've had multiple eye surgeries. Prep includes putting lidocaine jelly over the eye, which will immobilize your eye from movement during the procedure.
  - aeternum 5y ago
    This is also my greatest fear. The lidocaine isn't much consolation as it seems like it could easily wear off or they don't get the dose right and you move you eye.. the stuff of nightmares.
  - saruken 5y ago
    Thank you for this. That's the primary thing I wanted to know from this post too. Although I will say having my eyes immobilized also sounds scary. And I feel like I would constantly be "checking" that I still can't move them.
    - ignoramous 5y ago
      Don't stress-test stuff in prod.
  - hodgesrm 5y ago
    Same here. I've had surgeries for cataracts and detached retina (2 of each). Eye surgery has outstanding outcomes and involves virtually no physical discomfort. I'm profoundly grateful for modern medical technology, as I would otherwise likely be blind in both eyes.
mahathu 5y ago
I fully believe your professional assertion that eyeball injections won't hurt but this is probably the worst thing I ever read on HN.
- bigfudge 5y ago
  I had one of these and while it was awful to think about, the sensation was actually minimal. I wouldn’t hesitate in future…
4ad 5y ago
Jesus Christ, you have managed to make it worse than I thought it would be (and I expected it to be very bad). This is the stuff of nightmares, I would never do this while I was conscious. Hell, it would be better if there was pain.
edgyquant 5y ago
You might be right but I’m too much of a wuss to put eye drops in without flinching, let alone a needle
- spicybright 5y ago
  Tip: If you tilt your head back and squirt it in the corner of your eye (near your nose), it'll flow into your eye perfectly every time.
mcguire 5y ago
One of our friends has been having monthly eye injections for macular degeneration for a couple years. At this point, I'm more freaked out than she is. Better than the alternative.
notJim 5y ago
No offense to you, but this attitude is exactly the problem here. I know it's not rational to be very concerned about this, but I also know that the entire duration of that procedure, I will be thinking "KNIFE. IN. EYE." In the world I normally inhabit, knives should not ever be in eyes, so this is an incredibly stressful thought, stressful enough that I might do something crazy like MOVE WHILE A KNIFE IS IN MY EYE. This thought is even more stressful. The best advice for me personally is probably to breath deeply and try to relax.
- lotsofpulp 5y ago
  I like their attitude, gives me more confidence that they know what they are doing since they can explain it.
- ses1984 5y ago
  Sometimes they also give you something for anxiety, like valium.
  - Avshalom 5y ago
    To be fair the topical anesthetic is cocaine.
- xattt 5y ago
  Anything can be dissected (pun intended) to the point of disgust. Milk? That’s just cow blood that goes through one weird sweat gland. Honey? That’s bee vomit.
  - ignoramous 5y ago
    Thanks. I hate you.
    - xattt 5y ago
      Do you enjoy eggs? :)
- 5y ago
olegious 5y ago
As someone that had cataract surgery on both eyes in my early 30s, I just want to thank your profession for what you do. The experience was entirely painless, tooth cleaning at the dentist is more uncomfortable.
dirtyid 5y ago
This is reassuring but does not remotely allievate my irrational fear of eye based trauma.
deleted 5y ago
[deleted]
AlwaysRock 5y ago
Good lord just reading your description made me feel very uncomfortable.
wjamesg 5y ago
I had a detached retina a couple years ago and it was super scary experience. I am back at 20/20 with some wonderful work by my doctors (and some intraocular injections, for sure), although I am terrified of it happening again with permanent vision loss
kcplate 5y ago
I grew up believing the eye was basically like a balloon and one good poke… Whether or not that is correct..it’s hard to overcome something like that

by gdebel 5y ago

jmnicolas 5y ago

Counter point: a few years ago my mother had a botched cataract surgery, she now sees worse than before. Don't act like you don't take a chance on every medical procedure. Most of the times it's OK, but sometimes it's not. Then what?

s1artibartfast 5y ago

A couple questions: How are you using the surgical knife in your intravitreal injection procedure? Any thoughts on how often patients can see the needle? I always thought it was out of the visual axis, but some reports in this thread mention seeing it !?

randcraw 5y ago
I've had eye injections three times now and never saw the needle. I can't imagine you you could, since the eye can't focus on the needle since it's inside the lens which is necessary to focus what you see outside the eye onto the retina. I don't see how the fovea could receive a focused image of the needle without help from the lens.

coffeefuel 5y ago

I was born with cataracts and had the natural lenses in my eyes removed when I was days old. Fast forward to 2018 and I had intraocular lens implants (I believe it's called) under general anaesthetic. Went fine for the most part, however I had to go to A&E because the pressure in one of my eyes was ~65. The cause was blood leaking into the back of one of my eyes (if I remember correctly), and they had to use the drops you mentioned. At the time I was a bit concerned with what they were going to do, but obviously was willing to have whatever done to get back to normal. I'm still impressed by how well those drops worked. And, yeah. All I could see was red (blood), and all I felt was just a prick of something sharp. Was done within probably 10-15 minutes.

sdenton4 5y ago

My fun fun eye surgery was to remove a stye that had hardened into a chalazion. This didn't involve any actual needle/scalpel work on the eye itself, but did require flipping my eyelid inside-out and cutting into the back with a scalpel. The local anaesthetic worked great. A side effect of the eyelid-flip (I think) was that my eye rolled into a position that wasn't seeing anything. Overall, it was kinda like going to the dentist, but I could keep chatting with the doctor through the whole thing. The ability to keep communicating was great for keeping things chill. (However, one must be careful not to laugh while there's a scalpel near one's eye.)

metabagel 5y ago
I used to experience blepharitis and occasional sties, but of all things what cleared everything up was tea tree shampoo and face wash with tea tree oil. https://www.healthline.com/health/eyelash-mites https://www.healthline.com/health/eyelash-mites Keep any tea tree oil product well away from the eyelashes. It's not actually necessary to treat it there, and you'll regret it if you get any of the product in your eyes.
- sdenton4 5y ago
  Mine was caused by doing stressful grad school things, keeping ridiculously bad sleep schedules, and staring at a too-bright monitor for dozens of hours per day. These added up to rubbing my eyes a lot, which led directly to styes. After reducing my monitor brightness, the problem went away.
ignoramous 5y ago
Had that one myself. Looks way scarier in the videos: https://www.youtube-nocookie.com/embed/phWKZTsy2dg https://www.youtube-nocookie.com/embed/phWKZTsy2dg In reality, it is a not a big deal at all.
CallMeJim 5y ago
I had the same procedure on a lower eyelid, but the stye made the eyelid too thick to flip. An attendant had to force the eyelid down while the stye was lanced with a scalpel. For some reason, the anaesthetic didn't take effect. Pain.

cortesoft 5y ago

You can't tell me not to fear it. I have a HUGE eye phobia; I can't even open my eyes under water. It doesn't matter what anyone says, it isn't a rational thing.

rblatz 5y ago
This is so bizarre to me, to be an adult and just unable to control your own body? I guess I'm lucky to not have this issue, but man it's so foreign to me that you can't even open your eyes under water.
- burnished 5y ago
  Would you also not struggle to touch a hot stove? I think it is a similar feeling. Genuine question too - I've got a friend who is comedically brave and doesn't experience pain the way that other people do who might express a similar idea. He just already knows that its unusual and not the default.
  - rblatz 5y ago
    That’s an interesting idea. I think I’d be able to touch it, I know I’d dislike it immensely though. But this question helped me clarify my thoughts around this more. It’s the distinction between rational fear vs irrational fear. Assuming clean water the fear of opening your eyes underwater is irrational, it’s not going to hurt you or do any long term damage. The example from the story about getting an injection on your eye is maybe someplace in between, needle in the eye is much more invasive, but also deemed medically necessary where the risk of not doing it is greater than the risk of doing it. Not having the ability to override your own emotions in cases where they are irrational is interesting to me. It’s like giving agency to an “external other” that you have no control over.
    - doliveira 5y ago
      I seriously doubt you can rationally override your own emotions at any situation. And you should doubt that too, it can make you biased to think you're being rational without noticing you're not.

closetohome 5y ago

Thanks, I'd never really thought about eye surgery before and now am deathly afraid of literally every aspect of it.

axegon_ 5y ago

Thanks for this! Mind you, as much as I understand the importance and need of such procedures, that doesn't make me any less terrified. I've had all sorts of absurd injuries over the years all over my body and I am in no ways frightened or disguised of any bodily fluids. That said, I am terrified of the idea of such a procedure. Same with dental work - I abhor the feeling of anything being done to my teeth. Getting a wisdom tooth pulled out was arguably the most terrifying thing I've ever experienced. A needle going into my eyeball wouldn't feel any less terrifying.

joshlemer 5y ago

What happens if a patient accidentally looks left or right during the surgery? I would be afraid of subconsciously/accidentally looking one way or an other during the surgery, but would that not cause a catastrophe?

sedatk 5y ago
We call those happy little accidents.
iKnowKungFoo 5y ago
I've had multiple eye surgeries. Prep includes putting lidocaine jelly over the eye, which will immobilize your eye from movement during the procedure.
- aeternum 5y ago
  This is also my greatest fear. The lidocaine isn't much consolation as it seems like it could easily wear off or they don't get the dose right and you move you eye.. the stuff of nightmares.
- saruken 5y ago
  Thank you for this. That's the primary thing I wanted to know from this post too. Although I will say having my eyes immobilized also sounds scary. And I feel like I would constantly be "checking" that I still can't move them.
  - ignoramous 5y ago
    Don't stress-test stuff in prod.
- hodgesrm 5y ago
  Same here. I've had surgeries for cataracts and detached retina (2 of each). Eye surgery has outstanding outcomes and involves virtually no physical discomfort. I'm profoundly grateful for modern medical technology, as I would otherwise likely be blind in both eyes.

mahathu 5y ago

I fully believe your professional assertion that eyeball injections won't hurt but this is probably the worst thing I ever read on HN.

bigfudge 5y ago
I had one of these and while it was awful to think about, the sensation was actually minimal. I wouldn’t hesitate in future…

4ad 5y ago

Jesus Christ, you have managed to make it worse than I thought it would be (and I expected it to be very bad). This is the stuff of nightmares, I would never do this while I was conscious. Hell, it would be better if there was pain.

edgyquant 5y ago

You might be right but I’m too much of a wuss to put eye drops in without flinching, let alone a needle

spicybright 5y ago
Tip: If you tilt your head back and squirt it in the corner of your eye (near your nose), it'll flow into your eye perfectly every time.

mcguire 5y ago

One of our friends has been having monthly eye injections for macular degeneration for a couple years. At this point, I'm more freaked out than she is. Better than the alternative.

notJim 5y ago

No offense to you, but this attitude is exactly the problem here. I know it's not rational to be very concerned about this, but I also know that the entire duration of that procedure, I will be thinking "KNIFE. IN. EYE." In the world I normally inhabit, knives should not ever be in eyes, so this is an incredibly stressful thought, stressful enough that I might do something crazy like MOVE WHILE A KNIFE IS IN MY EYE. This thought is even more stressful. The best advice for me personally is probably to breath deeply and try to relax.

lotsofpulp 5y ago
I like their attitude, gives me more confidence that they know what they are doing since they can explain it.
ses1984 5y ago
Sometimes they also give you something for anxiety, like valium.
- Avshalom 5y ago
  To be fair the topical anesthetic is cocaine.
xattt 5y ago
Anything can be dissected (pun intended) to the point of disgust. Milk? That’s just cow blood that goes through one weird sweat gland. Honey? That’s bee vomit.
- ignoramous 5y ago
  Thanks. I hate you.
  - xattt 5y ago
    Do you enjoy eggs? :)
5y ago

olegious 5y ago

As someone that had cataract surgery on both eyes in my early 30s, I just want to thank your profession for what you do. The experience was entirely painless, tooth cleaning at the dentist is more uncomfortable.

dirtyid 5y ago

This is reassuring but does not remotely allievate my irrational fear of eye based trauma.

deleted 5y ago

[deleted]

AlwaysRock 5y ago

Good lord just reading your description made me feel very uncomfortable.

wjamesg 5y ago

I had a detached retina a couple years ago and it was super scary experience. I am back at 20/20 with some wonderful work by my doctors (and some intraocular injections, for sure), although I am terrified of it happening again with permanent vision loss

kcplate 5y ago

I grew up believing the eye was basically like a balloon and one good poke… Whether or not that is correct..it’s hard to overcome something like that