Intravitreal injections and iatrogenic dry eye

Iatrogenic dry eye secondary to intravitreal injections is an increasingly reported health concern, yet there’s a dearth of published scientific literature addressing this problem1. I recently completed a study at the University of Auckland to better understand the factors that contribute to the development of adverse ocular surface effects in patients receiving intravitreal injections. All health professionals administering intravitreal injections in New Zealand were eligible to participate. The anonymous online survey sought to gather data around the clinical practices surrounding the administration of intravitreal injections and clinicians’ perceptions of the impacts on the ocular surface.


A total of 23 responses from ophthalmologists and nurses were returned (equating to a response rate of approximately 18%). The relatively small sample size precluded meaningful statistical analysis but the results highlighted areas where evidence-based recommendations are lacking.


The survey identified some areas of consensus among healthcare practitioners and a number of marked inconsistencies, both in relation to the preparation for and delivery of intravitreal injections. The results highlight a need for safe practice standards around application of topical antiseptics and topical anaesthetics to be developed, particularly in relation to the volume and form of topical antiseptic used and the quantity of anaesthetic drops applied pre-treatment. Variability in practice appears to reflect a lack of high-quality scientific evidence in this area. This points to a need for more carefully designed studies with a view to informing standardised clinical practice recommendations on the administration of intravitreal injections. The research will also help inform future hypothesis-driven studies pertaining to the practice and processes surrounding the management of diseases requiring repeated intravitreal injection administration.



  1. Laude A, Lim JW, Srinagesh V, Tong L. The effect of intravitreal injections on dry eye, and proposed management strategies. Clin Ophthalmol. 2017 Aug 16;11:1491-1497.


Marc Maclean is a nurse practitioner based in Counties Manukau Health who recently completed a University of Auckland postgraduate research paper through the Department of Ophthalmology, supervised by Professor Jennifer Craig and Dr Ally Xue.


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