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Comment by gdebel | Hacker News Reader

(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.

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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.

I like their attitude, gives me more confidence that they know what they are doing since they can explain it.

Sometimes they also give you something for anxiety, like valium.

To be fair the topical anesthetic is cocaine.

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.

Thanks. I hate you.

Do you enjoy eggs? :)

This. I have an extremely strong blink reflex which I cannot overcome. The one time they tried to put contact lenses in my eye it took them 15 minutes to get them in and another half an hour to get them back out. It was one of the most stressful experiences I have ever had. It was over 30 years ago and it still makes me shudder to think about it. There is no way that I can possibly rational-ize my way out of that stress and convince myself that injections or surgery would not be ten times worse.

Blink reflex doesn’t really matter. If it’s anything like my Lasik surgery, they insert devices (like Clockwork orange) to make it impossible to blink — who wouldn’t have the urge to blink when something is approaching their eye? It’s an involuntary reflex for self preservation. They also put a ring in my eye that made it impossible for me to move my eye whatsoever regardless of my urge to look away.

Yeah, I get that. The issue is not that it wouldn't work, the issue is that I think it would be more traumatic for me then a normal person, and I base that assessment on the fact that putting contacts in is more traumatic for me than a normal person (like "extremely traumatic" vs "something so non-traumatic that they voluntarily do it to themselves on a regular basis").

I wore contact lenses for 10 years, before getting lasik.

The first time, it took 30 minutes to get them in.

For the first few months, I really struggled. Eventually it got easier, and in a short time I could put them in first time, every time

We're taught from a young age to not put things in our eyes, and it does take time to overcome that. The thought of it might be extremely traumatic now, but if you did it every day, you'd find that disappearing quickly.

Thanks, but I've been wearing glasses for 45 years now. I've made my peace with the fact that the contacts thing ain't gonna happen for me.

> We're taught from a young age to not put things in our eyes, and it does take time to overcome that.

I don't think we're really "taught" this, but is jut part of our innate programming. I never taught my cat anything, and I'm fairly sure if I were to put anything in her eye she would be less than happy about that, even if it doesn't hurt her.

I certainly never recall my mother telling me off for putting things in my eyes.

Well, by looking at all the answers, I obviously missed my point. Sorry for that :-) (I'm not a native english speaker as you noticed so it may also explain the misunderstanding ?)

Of course this is not how I talk to my patients... I usually explain the cataract surgery procedure as follows : "the only thing you will feel is water on the side of your face, and the only thing you will see is a very powerful light. You won't see anything scary and you won't feel any pain. We will talk during the surgery and when it will be over, you will tell me that you shouldn't have been afraid". And that's how it goes.

The eye injection procedure is even faster and painless.

Sorry for the gruesome details I gave.

Also, yes, don't look any Youtube videos, because your experience will be totally different than watching the procedure. Youtube videos are scary.

I am Deaf. How would you proceed if you need to do eye surgery on a Deaf person. I think they need to be knocked out. First, they care about their eyes more than other people and second you can't communicate with them during the surgery.

My own experience. I had to do an examination of my nose and throat with a camera on a stick (don't know the exact terminology). The doctor wanted to tell me something and I couldn't react because I couldn't turn the head to lipread and finally I tried to tear out the stick out of my nose and I struggled with the doctor and got a heavy slap on my hand.

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?

We call those happy little accidents.

I've had multiple eye surgeries. Prep includes putting lidocaine jelly over the eye, which will immobilize your eye from movement during the procedure.

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.

Don't stress-test stuff in prod.

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.

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.

The needle they use is short and does not extend very far inside the eyeball. (No, you can't see the needle.) If the eye jerks while the needle is inserted, it won't move far. Eyeball tissue is thick and strong and the presence of the needle will limit the eye's motion to only about 2-3 mm, doing no damage. The needle enters the side of the eyeball, peripheral to the sensory part of the retina.

An eye flinch is exactly what happened to me when I got my latest injection of VEGF-inhibitor to counteract macular degeneration due to 20+ years of diabetes. It was no big thing, just a little disconcerting.

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

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

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.)

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

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.

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.

Had that one myself. Looks way scarier in the videos: https://www.youtube-nocookie.com/embed/phWKZTsy2dg In reality, it is a not a big deal at all.

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.

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.

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.

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.

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.

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.

It seems like you are stretching my words here.

If I absolutely needed to open my eyes under water for an important reason, I likely could. That is just not a common situation and I haven't encountered it.

I don't think not opening my eyes under water is THAT irrational, really. My reason for keeping my eyes closed (my fear and not liking the feeling of water touching my eyes) is greater than my need to open my eyes under water (which has been no real reason so far).

Well, I think you're getting close, but you still seem to be coming at this from a place of presumed superiority, mostly due to the separation of fears into 'rational' vs 'irrational'. Part of TFA is that they were not given enough information - is it irrational to fear some one stabbing your eye just because they are also confident that it will be for your betterment? From your water example it is clear also that you've learned that some water is safe to open your eyes in and built confidence in that knowledge - what if you hadn't had those experiences? Where I grew up the water was painfully cold, frequently polluted, and silty enough that I wouldn't be surprised if you got a scratch on your eye from doing that. I learned to open my eyes in the water in a public pool and discovered that I could do so with only minor irritation. If the chemical balance had been different that probably would not have been the case.

I think another perspective that might be helpful is to think of this in terms of the flinch reflex. Anyone can control theirs (this is an emotional process, sure), but the difficulty involves how sensitive they are, how strong the input is, how necessary they deem the action, and how afraid they are of potential consequences. Again, I don't think 'rational' or 'irrational' comes into play here or explains anything extra, I think in your case for example you are probably not jumpy (overly sensitive), and confident that your outcomes will be acceptable. I think the author was probably a little jumpy and was not confident in the outcome of an eye-poke.

Phobias are very common. Almost everyone has one, like fear of heights or being trapped in a small space. The fear is not rational, and the phobic is well aware of that, but simply knowing it's irrational doesn't help rid you of it.

https://en.wikipedia.org/wiki/List_of_phobias

I think you might be overestimating what I mean by "can't" open my eyes under water. I think the 'touching a hot stove' metaphor is a good one. It feels like that to me.

It could be that you just don't have very strong emotions. The "dynamic range" of felt emotion varies greatly between individuals.

Yeah if you are afraid to open your eyes underwater there is no way your letting a needle come near your eye when you are conscious and can see it. I have never heard of this eye phobia very interesting

I don't open my eyes either but mostly in swimming pools full of chlorine. Didn't know it was a phobia, because all I'm trying to do is avoid annoying eye irritation.

Talking about eye surgery is like nails on a chalkboard to me. I don’t want to talk about yours, let alone think about mine.

I have joked with my friends and family about giving them a limited power of attorney that in the case of eye or testicular surgery they can dose me with tranquilizers or anti anxiety meds without my knowledge and deliver me to the surgeon, having not told me that my surgery is today.

They’re not sure if I’m kidding, and neither am I.

Have you tried watching videos of surgeries to see if you can acclimatize your fear? Starting with something trivial like a skin suture or mole removal might be tolerable. Exposure therapy is an established way to gradually inoculate yourself against a fear that seems inescapably overwhelming.

> Have you tried watching videos of surgeries to see if you can acclimatize your fear?

If you're anxious enough already, then: Don't. Ever. Do. This. Videos don't help, at all. And your brain is constantly thinking about ways things might have gone wrong, while simultaneously looking (no pun) for comments from people explaining how exactly things went wrong for them!

I'm the same way. I even have a hard time with drops despite using them regularly for years. I understand perfectly well that it's completely irrational yet I have not found a way to gain control over it.

>You can't tell me not to fear it.

They didn't. They said don't postpone your treatment and suffer irreversible vision loss, due to fear.

>To any future HN reader scared by those intraocular injections: don't fear them.

Missed that, thanks.

Pre-surgery benzodiazepines might fix that and are given to particularly anxious patients - I was terrified going into a surgery and was given those, ten minutes later there was total relief. I can easily understand the addiction risk (and haven't had them since), but for acute anxiety it was wild how much of a relief it was.

I went from nervous with fairly intense physical symptoms to being totally chill.

The trick is to take the entire day off of work, take xanax, and do the motions without panicking.

The feeling you're describing is literally panic from an anxiety disorder. If it it's interfering with your adult responsibilities (like going to the doctor), that's the right time to use medication to get through it.

My toddler recently scratched my cornea with a finger, and while I was completely traumatized, I was able to go to the doctor and allow them to treat me. The phobia is not quite debilitating, just strong.

I have pretty high pain tolerance, but I can't handle eye injuries. I had a scratch on my cornea back in high school and I still remember how there was no ignoring it and nothing that alleviated the pain. Got a corneal ulcer a few months ago from the fancy 24/7 contacts the optometrist sold me. It wasn't near as bad as I remember the scratch being, but I definitely called into work and hid under the covers for a full day.

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.

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

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.

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

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

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

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?

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 !?

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.

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.

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.

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

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.

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

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.

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