What to do in case of post intravitreal injection bleeding?

Management of Post-Intravitreal Injection Bleeding

In case of post-intravitreal injection bleeding, observation and conservative management is the recommended approach as most cases resolve spontaneously without intervention.

Types of Post-Injection Bleeding

Subconjunctival Hemorrhage

• Most common and benign form of bleeding
• Appears as bright red patch on the white of the eye
• Typically resolves spontaneously within 1-2 weeks
• No specific treatment required beyond reassurance 1

Anterior Chamber Bleeding

• Less common complication
• Can occur without associated vitreous hemorrhage
• Conservative management is appropriate in most cases 2
• Monitor intraocular pressure to ensure no complications develop

Vitreous Hemorrhage

• More serious but less common complication
• May temporarily obscure vision
• Requires careful monitoring but often resolves without intervention
• Position patient with head elevated to help blood settle 1

Management Protocol

Immediate Assessment

1. Evaluate visual acuity to establish baseline
2. Measure intraocular pressure to rule out pressure-related complications
3. Perform slit-lamp examination to determine location and extent of bleeding
4. Conduct fundus examination (if possible) to assess retinal status

Management Steps

1. For minor bleeding (subconjunctival hemorrhage):

   • Reassure patient about benign nature
   • No intervention required
   • Follow-up as scheduled for the underlying condition

2. For anterior chamber bleeding:

   • Conservative management is typically sufficient 2
   • Monitor intraocular pressure
   • Consider topical anti-inflammatory drops if significant inflammation present

3. For vitreous hemorrhage:

   • Head elevation to allow blood to settle
   • More frequent follow-up (1-2 weeks initially) 1
   • B-scan ultrasonography if fundus cannot be visualized to rule out retinal detachment

Warning Signs Requiring Urgent Attention

• Sudden worsening of pain or vision
• Significant increase in intraocular pressure
• Signs of infection (increasing redness, pain, photophobia)
• Persistent or worsening hemorrhage

Prevention of Bleeding Complications

• Proper injection technique with needle directed toward optic nerve via pars plana
• Use of povidone-iodine prior to injection
• Adequate anesthesia to prevent sudden movement
• Applying gentle pressure at injection site after needle withdrawal 1
• Consider topical naphazoline to reduce conjunctival hemorrhage 3

Special Considerations

• In patients on anticoagulants, continuation of therapy is generally recommended as the risk of thromboembolic events outweighs the risk of serious hemorrhagic complications 1
• For diabetic patients receiving anti-VEGF injections, regular follow-up is essential as they may be at higher risk for complications 1

Follow-up Schedule

• For minor bleeding: routine follow-up for underlying condition
• For moderate bleeding: 1-week follow-up
• For significant bleeding: 2-3 day follow-up with consideration of more frequent monitoring

Most post-intravitreal injection bleeding is self-limiting and resolves without intervention. The primary focus should be on monitoring for potential complications while providing appropriate reassurance to the patient.