Eye injections, or intraocular injections, have revolutionised the field of ophthalmology by providing targeted and effective treatment for various eye conditions. These injections involve the direct administration of medications into the eye, bypassing the traditional oral or topical routes. This is an area in which nurses have expanded their scope of practice and eye injections are a procedure that can be carried out by clinical nurse specialists. 

This article explores the significance, types, administration techniques, associated risks, benefits, patient safety considerations and relevant guidelines for eye injections in Ireland.¹

Significantly, eye injections have emerged as a breakthrough treatment modality in ophthalmology due to their ability to deliver medications directly to the site of the problem within the eye. Traditional treatments such as eye drops or oral medications may not reach therapeutic concentrations within the eye due to the blood-retinal barrier, limited bioavailability or poor ocular penetration. In contrast, eye injections ensure higher drug concentration at the target site, leading to improved treatment outcomes.²

Another type of injection is corticosteroid injections, such as triamcinolone acetonide or dexamethasone, which are used to treat conditions such as uveitis, macular oedema and specific inflammations. These injections possess anti-inflammatory properties that reduce swelling and suppress immune responses within the eye.³ Immunomodulatory injections, including methotrexate or adalimumab, are employed for the management of inflammatory eye conditions such as non-infectious uveitis or ocular surface diseases. These injections modulate the immune system, diminishing inflammation and preventing further ocular tissue damage.⁴

In administering eye injections, ophthalmologists or retina specialists typically perform the procedure in an outpatient setting. The process involves several steps to ensure safety and efficacy. To minimise discomfort, the eye is numbed using topical anaesthetic eye drops, and in some cases a sterile lid speculum may be used to keep the eyelids open.⁵ The injection itself is administered by the ophthalmologist using a small-gauge needle, targeting the sclera (white part of the eye) or the area around the iris (pars plana), depending on the specific area requiring treatment.⁶ Following the injection, patients may receive antibiotic or anti-inflammatory eye drops to prevent infection or manage post-injection inflammation. Compliance with post-injection care instructions provided by the ophthalmologist is crucial for optimal outcomes.⁷

Patient safety is of utmost importance during eye injections, and HSE guidelines help to ensure safe practices. Infection control measures are closely followed, emphasising proper hand hygiene, aseptic technique and appropriate sterilisation of equipment to prevent injection site infections.⁸ Patient identification procedures and obtaining informed consent are essential steps to ensure accurate administration of the injection and involve the patient in the decision-making process.⁹ 

Healthcare professionals involved in eye injections receive adequate training and demonstrate competency in the procedure, with regular updates and continuing education to maintain their knowledge and skills.¹⁰ Comprehensive documentation of the injection procedure, including medication used, dosage, injection site and any adverse events, is vital for patient safety, continuity of care and medico-legal purposes.¹¹ Collectively, these guidelines contribute to the safe and effective administration of eye injections, prioritising patient wellbeing.

In summary, eye injections have revolutionised the management of ocular conditions. Different types of injections, such as anti-VEGF, corticosteroid and immunomodulatory injections, offer specific therapeutic benefits. 

Adhering to proper administration techniques and following patient safety guidelines, including infection control measures, patient identification and consent, staff competency and training, as well as meticulous documentation, ensures the safe and effective use of eye injections.

These advancements in ophthalmology offer hope for patients with sight-threatening diseases and contribute to improved visual outcomes and quality of life.

References

1. Kim SJ, Toma HS. Intraocular drug delivery: an overview. Curr Pharm Des. 2015;21(31):4692-700
2. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432-44
3. Haller JA, Bandello F, Belfort R Jr, et al; Ozurdex GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117(6):1134-46.e3
4. Nguyen QD, Merrill PT, Jaffe GJ, et al; MMAP Study Group. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet. 2016;388(10050):1183-92
5. American Academy of Ophthalmology. Basic and Clinical Science Course, Section 7: Orbit, Eyelids, and Lacrimal System. San Francisco, CA: American Academy of Ophthalmology; 2018-2019
6. Hoang QV, Chau FY, Shahidi M, et al. Intraocular injection techniques: anesthesia and medication choice. J Ophthalmol 2017; 2017:8938496
7. American Society of Retina Specialists. ASRS Patient Information: Eye Injections. [https://www.asrs.org/patients/retinal-diseases/24/injections]
8. Health and Safety Executive. Guidelines for Healthcare Workers on Safe Practice in the Administration of Intra-ocular Injections. Accessed July 18, 2023. [https://www.hse.ie/eng/about/who/qid/other-resources/guidelines-for-healthcare-workers-on-safe-practice-in-the-administration-of-intra-ocular-injections.pdf]
9. Royal College of Nursing. Informed Consent. [https://www.rcn.org.uk/get-help/rcn-advice/informed-consent]
10. Health and Safety Executive. Safe Management of Healthcare Waste. Accessed July 18, 2023. [https://www.hse.gov.uk/waste/healthcare/index.htm]
11. Health and Safety Executive. Guidance on the Legal Requirements of the Health and Safety at Work Act