I was terrified of an eyeball injection

(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.

I have diabetes. My glucose control at home is fairly good because almost everything I eat has a nutrition label, and I can calculate somewhat accurately exactly how much insulin I need to take. When I travel, eating in restaurants regularly, I have to make wild ass guesses as to how much carbohydrate I'm consuming. On a recent trip I had some health issues, including a significant spike in my glucose readings. My A1C went from 6.9 to 8.4 and I had noticeable vision problems. I went to my ophthalmologist and he told me that I had serious retinal bleeds, and I would need injections in both my eyes. It was serious enough that he gave me the first injection in one eye that day, and the second injection in the other eye the next day. My ophthalmologist is very good and I trust him implicitly. The procedure involved antibiotic drops in my eyes, anesthetic drops, and betadine on my eyelids before the injections. The needles used were very small gauge (they looked like 32 gauge). I didn't feel any pain; just a slight feeling of pressure.

If you have a good ophthalmologist, nowadays there is little reason to fear getting injections in your eyes.

> We briefly discussed my anxiety, but his immediate solution was the anti-anxiety drug. I made it clear that I was worried about the procedure and wanted to know more details about it. He didn’t want to explain the procedure beyond “we’ll inject medication that will help preserve your vision”, and he avoided answering repeated questions. Maybe he tried to shield me from the details and not confirm my worst fears.

Based on stories I've heard from emotionally immature doctor friends and my own experience being a little more confrontational with my doctors, he most likely didn't know the answers to your questions and was too proud to say, "I don't know."

It seems many forget that, at the end of the day, doctors are people, too, with just as many flaws and emotions as the rest of us. It's unfortunate that this affects quality of care, but it's a fact of life in every industry.

The best thing you can do for yourself in such a situation is to prepare yourself before appointments and remember the humanity of doctors during appointments. If your doctor is being dodgy about answering questions, let them know that it's okay if they don't know and that you won't think anything less of them for it. If it's an urgent matter, suggest looking it up together so that your doctor can provide context for whatever research you manage to find.

A doctor is like a contractor you've hired to inspect and maintain your body. As with any contractor, if you want them to do a good job, you have to work with them, as a team.

I've been getting these eyeball injections this year. (1 eye, every 6 or so weeks).

Bedside manner of the doctors and technicians is the most important aspect of it. I have a Doc who wonderfully calm and hires a pretty good staff.

One thing the writer doesn't mention is how long all this takes. For me it's usually 2 hours of my time. I go in, get my eye scanned, then dilation drops are applied, then I wait 45 minutes for them to kick in. After that they, bring me back into a room and start applying various things to my eye: antihistamine drops, numbing agent, something to sterilize my eye, and an antibiotic (I think). All the eye prep takes 20 minutes or so. Then the doc steps in to do his thing, and that takes all of 5-10 minutes.

For those curious, you don't see the needle, you end up looking toward the bridge of your nose and the doc comes from the opposite direction. You don't see it inside your eyeball either. You do see the fluid stream in and it dissipates quickly. If there is a bubble in the solution you end up with one or a few black dots floating around your vision, those dissipate in a day or two. You don't feel anything other than a little pressure on your eye. Afterward, you might have some eye pain. This depends on how good of a stick it was and how your allergies are doing. Sometimes you are relatively pain free afterward, but other times it feels like your eye got walloped and your eye will be sore for a few days.

I have double vision because of previous eye surgery, and the end result is going to be a surgery where they

1. Put me under

2. Disconnect the muscles from the back of the eye sockets and reconnect them temporarily in a better location

3. Wake me up and make sure the locations are correct

4. Push the eyes to the side and reach in with a tool to permanently attach the muscles

The doctor was telling me the last part and I was staring at her like she was insane; "wait.. while I'm awake?!?". My plan is to just schedule a psychological appointment for later the same day.

I wonder if some people cope better with knowing less. If the procedure for removing the stitches from my eyeball had been explained in advance, I'd still have them now.

Going in, I'd imagined the best possible outcome. This, of course, didn't bear much relationship to what followed.

No doubt some people would have steeled themselves first given more information. (And perhaps been more stoic!)

This is a pretty common procedure that many are unaware of because it largely affects the elderly.

Around 2.5 million ocular injections are performed a year in the US and the busiest retina specialists perform as many as 50 per day.[1]

As many as 11 million people in the United States have some form of age-related macular degeneration. This number is expected to double to nearly 22 million by 2050.

Many patients require periodic injections for the rest of their lives

https://assets.bmctoday.net/retinatoday/pdfs/0520rt_AMD_MacC...

My mother accidentally put mosquito repellant in my eyes as a child (my father had put it in an eye dropper to carry hunting and didn't label the bottle)

To this day anything that messes with my eyes freaks me out. That little puffer thing at the eye doctor? That thing is my nemesis. I won't wear contacts. Lasik is out of the question because on top of this phobia I also have CP and I get super spastic when stressed.

Having to get monthly injections in my eyeball would be pure nightmare fuel for me. I'm not sure which I'd fear more, that, or going blind.

I have a lot of sympathy for the author. I've been thinking about getting LASIK (or SMILE as it seems to be gaining popularity in France) since friend got it and says it's life-changing, and since I've started considering it I sometimes have nightmares about the procedure.

I already had some minor surgery with local anesthesic and I didn't have any anxiety, but there's something about having something done to the eyes while fully awake that I find frightening.

Not to brag, but to brag, this is nothing. I’ve had a gas bubble injected into my eye to repair a detached retina (pneumatic retinopexy).

https://www.google.ca/amp/s/www.hopkinsmedicine.org/health/w...

I had 3 shots of Avastin to fix a neovascularization in my retina [1] around the end of 2010.

I have to say, it's not a very pleasant treatment. I vividly remember the image of the needle inside my eyeball and the liquid squeezing in (Avastin has a refractive index slightly different than the vitreos). But at least now I have a cool icebreaker when I get my flu shot every now and then :D

[1] - https://pubmed.ncbi.nlm.nih.gov/17011951/

A close relative needed cortisone to manage an eye infection post eye surgery. The insurance stopped paying for the cortisone drops after a while, the only thing they would pay for were injections. The procedure consisted of a large syringe that was used to inject a literal pellet that would float around in the eye and slowly give off cortisone over multiple weeks. My relative said they could sometimes see the pellet float through their eye as it intercepted light on its way to the optical nerve. It manifested as a circular shadow in their field of vision. They called it their "satellite".

The thing that struck me the most, is that a human eye seems to be pretty puncture tolerant before it starts to leak. Also, the insurance's decision is hard to understand: The injections cost $2k compared to a couple hundred for the eye drops. And once the pellet is in, you can't get it out to reduce the dosage.

When I was a child I used to sometimes touch my eyeball with the tip of a pencil. Everyone I've told this to is very freaked out by it. For me it was a test of my own self control. Could I keep my eye open? Could I be steady enough to not stab my eye? You can't really see the pencil approaching in any detail. It's really out of focus. The eyeball itself doesn't really feel much. The key is not hitting your eyelashes because those are super sensitive and will cause you to blink and withdraw immediately.

I think the touching the eyeball with a cotton swab thing would work. It's not that scary once you've done it a few times. But the thought of an injection does still scare me a bit.

As someone who isn't far off this level with regular injections in regular places, I have a lot of sympathy for the author. Based on my past experience I'd expect it to take me a couple of years to get to the point of being able to do this, and I have no real anxiety about my eyes.

Well done to the author for not giving up.

Reminds me of Issac Newton, who had the total opposite attitude towards needles in his eye. He poked holes in his cornea as an experiment.

This was discussed recently here on HN, but I couldn't find the submission. Here's a link to another story about it: https://jsaulburton.com/2014/07/27/isaac-newton-his-eye-and-...

I can relate to this story a bit.

I had an Avastin injection in my eye 10ish years ago in my mid 20s. It turned out that I had a central retinal vein occlusion which caused me to suddenly lose vision in one of my eyes. There was lots of hemorrhaging and swelling of macula which made me lose vision.

One of the suggested ways to treat some of the swelling was by injecting Avastin into my eyes. The ophthalmologist said that there weren't really anything else to do at that point besides to let the eye naturally heal so I did take the chance to take the shot.

I experienced all of that anxiety that the author wrote about as just the thought of a needle injection into the eye is truly gruesome. But what everyone else on here have said is correct in that, they put all this stuff on you, antibiotic drops, anesthetic drops, and betadine and then they have you look up in the upper right hand or upper left hand corner as they inject into the white of your eye.

I remember this being the excruciating part as once the needle goes in, you shouldn't move your eye at all and keep it in that position or risk blindness (as the ophthalmologist put it). What was seconds seemed like minutes. Due to all the anesthesia, you feel no pain but you do feel this discomfort of pressure as the needle gets inserted into the eye.

Thankfully, I only required just one injection but I knew a lot of other elderly with macular degeneration and such who needed these injections regularly in order to not lose vision. The whole process was pretty professional but I don't know if I would want to go through that all again but I know that if it was between that or lose my vision, I think most people would decide to get the injections.

I can sympathize. I had a seed fall into my eye while out on a walk and it wouldn't come out. Had to to to the ophthalmologist. She did local drops and took it out with forceps. It was uncomfortable and scary but she did a great job at calming me down and doing it quickly. I do think eye doctors have this kind of thing down and folks needn't worry anymore.

I've been Type 1 diabetic for 10 years. Even though my glucose control is excellent over that period (A1C never >6.5%) I've never been able to shake the latent fear that it's a matter of time before I develop complications like retinopathy. What sucks hard is that it's not _just_ determined by insulin and glucose. Exercise, stress, activity level, protein/fat intake, illness, and more can all cause massive variability in glucose levels and insulin sensitivity. Therefore my most successful blanket strategy for glucose control is keeping as consistent a routine as possible: eating the same foods, doing the same activities - at the same time, always exercising regularly, and avoiding spontaneity.

While I've always had anxiety, it's only become worse over the years given the fear of having issues in both day-to-day blood sugar management and in being diagnosed with long term complications. Living with T1D often feels like a case study in applied stoicism.

Well I was nervous after reading the title. Reading the article as a diabetic-of-fifteen-years with suboptimal glucose/health management made me positively queasy. I’m taking this as the sign that I need to get my shit together, and I recommend anyone else who’s also procrastinating like me to take this opportunity.

Many of us will face eye injections as we age and develop macular degeneration, where eye injections are currently the best treatment to slow and stop age based macular degeneration.

Type two diabetes can be reversed with diet, maybe those facing this procedure will get more motivation to try stricter dietary interventions.

Makes me shudder...

I had some systemic inflammation behind my retina that would flare up every year or two, causing my retina to warp and make everything look like a fun-house mirror. (At least with the good eye closed... with both open, the brain sorts it all out and provides a good image...)

To reduce the swelling, I needed steroids shots towards the BACK of the eyeball! Speculum goes in, then the doc puts his thumb on the eyeball and rotates it so that I’m looking into my own brain (it seemed) and injects something... aargh!

Didn’t help they he was 76, had shaky hands, and would say things like “now don’t move or you’ll go blind... haha.”

Not all that painful, though... the anesthetic drops numb everything. But, the most disturbing medical experience I’ve had.

(Of course, I’m a guy... I doubt it’s as disturbing as squeezing a baby out of a small orifice in your groin, so there’s that...)

This reminds me of a fun internet rabbithole. Feeling a little too comfortable? Need a little spice in your life? Why not watch some... surgery videos?

In the wake of having multiple surgeries myself, I became interested in watching procedures like the one in the article actually being performed. For example: https://www.youtube.com/watch?v=DQfRKTKmq80 (warning: may be disturbing).

I don't consider myself squeamish, but just try finishing a video of, say, knee-replacement surgery. Imagine carpentry, with someone's living bone. Yikes.

Massive respect for the people who successfully do this every day without being completely overwhelmed by the complexity, the high stakes, and, especially, the cringe-inducing gore.

As someone who experiences medical anxiety regularly, this reminds me of basically every dermatologist visit I’ve had.

The doctors who cut biopsies out of your skin don’t seem realize how much you’ll think about there words when you leave. “How long has that been there? That looks a little concerning. That seems strange.”

Doctors have to deal with patients of all kinds of mental fortitude of course, but it wouldn’t hurt to be clearer about procedures, concerns, etc.

For example, tell me “I bias towards taking a biopsy if I have even a little bit of doubt.”

I personally hope I will never need an eyeball injection. Then again, there are people who volunteer to having their eyes not only immobilized and then poked and prodded repeatedly, but also bombarded with laser beams, to be able to see better: https://en.wikipedia.org/wiki/LASIK#Operative_procedure - I have a lot of respect for anyone who is brave enough to go through this...

I’ve had 4 cornea transplants and PRK (like LASIK but no flap). Before I started I was very nervous and sensitive to anything touching my eyes. Now it’s like, whatever, do what you need to do.

The anxiety is worse than the procedures, by far. I don’t have any helpful advice to give; I just toughed it out. The only bad experience I ever had was during my second transplant. They conduct transplants under conscious sedation plus local anesthesia. The sedative puts you to sleep for a few minutes while they nerve block the side of your face with Novocaine and then they wake you up a little for the procedure. I found the procedure profoundly disturbing psychologically even though I was in no discomfort. They use a trephine (like a small razor sharp cookie cutter) to remove your cornea; you’re awake and can sorta see it. It makes squishy noises. Your vision skews all over and then goes really blurry and you realize that there’s nothing but gravity keeping the insides of your eye in. After that I always asked the anesthesiologist to sedate me just to the point where I was unconscious or at least not aware/lucid.

Most doctors are very caring people and used to addressing anxiety. Maybe not surgeons so much, at least in my experience.

I've had 2 cornea replacements. In 5-10 years I'll need them replaced again, (and repeat until I die or go blind).

I was freaking out for 6 months about the entire operation. The more research that I did, didn't help. Even support groups that had gone through it didn't help. I was terrified.

The first eye: I took Xanax before the procedure, and they gave me something to calm me down. I was partially aware of life for 10 minutes after I was almost home.

The second eye: I didn't take Xanax, and partway through the procedure I woke up enough to be able to feel them working in my eye. I was calm and not bothered by it. It felt more like a tugging and pulling (like how your foot associates your shoe-laces being tied); but I was calm. The doctor told me to stop moving my eye. They must have given me something more, because I don't remember anything else.

It's an out-patient procedure.

If you are in a similar position and have ANY questions, I'll talk to you about it.

There will be a hundred people who say: "If I can do it, anybody can!" I don't want to be dismissive about your feelings. I was in horrible shape before the procedure.

But I will be honest with you and talk about it if you want.

I couldn't even finish reading the article, the prospect sounded so horrifying.

This author is a king.

I had to have my tonsil biopsied a few years back. With my mouth agape and a six-inch needle down my throat, my ENT quipped:

> I did this once, I learned a lot.

Surprisingly that was the most comforting thing I could hear. To know that the ENT had enough confidence and presence-of-mind in his procedure to crack a joke told me I was in good hands, even if those hands were holding a six-inch needle down my throat.

Did anyone else get mentally scarred by the Dali video of woman's eye being slit by a razor. Accidentally saw it a few times on TV when I was young, big reason I don't have cable anymore. Every once in a while I still get get paranoid about accidentally stumble across it in gif form. Fingers crossed we'll get ability to filter out visuals like words someday.

I have choroiditis. It has formed patches of dead zones in my retina, maybe due to a faulty gene. I have to get steroid injections to my eyeball (intra-focal administration) whenever there is a significant flareup.

That bring said, I was apprehensive the first time. But you have to trust the doctor and his skills. The injection itself doesn't hurt. There are no pain receptors in that zone. Only a faint prick when the needle pierces the sclera (the white outer skin of the eyeball).

In my case, the doctor explained me before what I had to expect. A sort of cost-benefit analysis: "Bear your anxiety for a few seconds and the disease gets under control". It helps to understand what is at stake. Also, knowing the physiology of the process eases the nerves. If I know there is no nerve ending to feel the pain, I know I will be more relaxed.

Protip: I keep my fist clenched to my belt & gaze fixed to a spot to prevent any accidental movement.

Is there no way they can do this while you're unconscious?

I have had a long-term phobia of needles. This is excacerbated by the fact that I'm usually in some sort of stressful situation at the point at which a needle is being put into me: be it a part of a diagnosis with thoughts racing about outcomes, or worse in an acute emergency.

I recently took positive action to try and dispel this fear with a sort of exposure therapy: I started giving blood. It's a much less stressful environment, that feels much more under control. So far I haven't had any issues at all, which is a surprise to me. It hurts a bit when the needle goes in, but my heart does not race, nor do I get a massive hit of adrenaline. I'm on my third donation, and next time I need to have a needle inserted for something else, I hope I'm a lot less troubled by it.

The obligatory reference to Bunuel's and Dali's 'Un Chien Andalou' for the ommetaphobe:

https://www.dailymotion.com/video/x4cbwvf

https://en.m.wikipedia.org/wiki/Un_Chien_Andalou

https://en.m.wikipedia.org/wiki/Ommetaphobia

I’m curious why it seems they were seemingly conservative with the anti-anxiety meds? A large enough benzo dose would turn this from the worst day ever to a relaxing experience in just a few minutes.

I had a laser iridotomy a few weeks ago for "narrow angles". Other than feeling like you're in a staring contest with Locutus of Borg, it was quick and painless.

There was an interesting observation that practitioners optimize for themselves, not the patients[1]. When you're seeing dozens of patients a day, each of them reacting differently, it's hard to empathize fully with, and adapt to, each of them. The one you can optimize for, as the practitioner, is yourself.

[1] Dan Ariely, in the intro of his must-read book "Predictably Irrational"

I'm very sympathetic to the author. I had to take a few breaks reading this article. Eye damage, things coming close to my eyes, or needles near my eyes are pure nightmare fuel as long as I can remember. "Fire in the Sky"'s experiment scene really pushed this over the edge for me as a child. I still get queasy thinking about it.

Try watching a cataract operation on YT without being OMGOMGOMG

> Surely other patients must have asked about [this traumatic experience]? Or commented on it?

I find myself having this reaction all too frequently after traumatic encounters with the healthcare system.

I honestly don't know the answer. Do other patients really not communicate when they have a bad experience? Or do they communicate and the system is simply incapable of listening or reacting?

I had cataract surgery when I was 15/16 and since I was underage I was fully knocked out for the procedure (thankfully) but what I find to be a funny aspect about that whole thing is that wheeling me in a bed (having already taken some kind of oral anesthetic in tablet form) from the patient room to the operating room (down 4 floors, across, then up a few floors) took up essentially the same amount of time as the actual procedure.

After the operations (first one eye, wait a month, then the other eye) I had to wait six months to be fitted for glasses with "progressive lenses" (having used store-bought reading glasses inbetween) and I was done.

Over the ~10 years since then I've had to have my eyes lasered two times because that pesky cataract tried to grow back otherwise I just have a rather glare-sensitive pair of eyes[0] with a fixed focus length (due to the artificial lenses) making me both far- and near sighted[1] at the same time. Also the glasses are expensive, to the tune of 180-200€ per lens ie. ~400€ without the frame.

TL;DR: it sucks but it's better than the alternative, going blind before or by 20 years old and having seen the difference [2] in the month between my initial two cataract surgeries it's well worth it.

[0]: outside on sunny days w/o sun glasses has me almost constantly blinded if I look anywhere near the sun's direction or any sun-reflecting surface (non-matte metal, glass, wet roads, water surfaces from puddles to the sea or any sufficiently light-colored surface, think paper or white walls etc.); ALSO software/websites that don't have a dark color theme genuinely become straining to my eyes within minutes if not seconds, so take note software engineers and web-devs, dark themes are not some hipster fad but a genuine accessibility feature

[1]: near-sighted from childhood astigmatism (extent: fine details and separations between objects further than ~50-100m become blurry), far-sightedness (extent: without glasses I can't read normal documents nearer than my fully extended arm, visually becoming just black fog/smudges on the white background) from the IOLs (intraocular lenses), IIRC the IOLs were made to make me more far-sighted with the idea that I would get more near-sighted with age anyway to some extent cancelling each other out.

[2]: the not-yet-operated eye couldn't even see a large smokestack ~2-3km away, there was just fog starting at around 1km away, the operated eye could see them perfectly fine on the horizon