Ocular decompression with cotton swabs lowers intraocular pressure elevation after intravitreal injection

Ninel Z. Gregori, Matthew J. Weiss, Raquel Goldhardt, Joyce C. Schiffman, Edgardo Vega, Cherrie Ann Mattis, Wei Shi, Linda Kelley, Vilma Hernandez, William J. Feuer

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: To determine the effect of preinjection ocular decompression by cotton swabs on the immediate rise in intraocular pressure (IOP) after intravitreal injections.

Methods: Forty-eight patients receiving 0.05mL ranibizumab injections in a retina clinic were randomized to 2 anesthetic methods in each eye on the same day (if bilateral disease) or on consecutive visits (if unilateral disease). One method utilized cotton swabs soaked in 4% lidocaine applied to the globe with moderate pressure and the other 3.5% lidocaine gel applied without pressure. IOPs were recorded at baseline (before injection) and at 0, 5, 10, and 15 minutes after the injection until the IOP was ≤30mm Hg. The IOP elevations from baseline were compared after the 2 anesthetic methods.

Results: The preinjection mean IOP (SD, mm Hg) was 15.5 (3.3) before the cotton swabs and 15.9 (3.0) before the gel (P=0.28). Mean IOP (SD, mm Hg) change immediately after injection was 25.7 (9.2) after the cotton swabs and 30.9 (9.9) after the gel (P=0.001). Thirty-five percent of gel eyes had IOP≥50mm Hg compared with only 10% of cotton swab eyes immediately after the injection (P<0.001).

Conclusion: Decompressing the eye with cotton swabs during anesthetic preparation before an intravitreal injection produces a significantly lower IOP spike after the injection.

Original languageEnglish (US)
Pages (from-to)508-512
Number of pages5
JournalJournal of glaucoma
Issue number8
StatePublished - Dec 10 2014


  • Anti-VEGF agent
  • Eye decompression
  • Intraocular pressure
  • Intravitreal injection

ASJC Scopus subject areas

  • Ophthalmology


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