I’ve been a bit freaked out over the last couple of months. I needed to inject a medication directly into my eyeball. My. Damned. Eyeball! I’d never heard anyone talk about this procedure before, and I’d like to share my experiences. Maybe it can help you be less clueless about it than I was.
It’s my 30-years-living-with-diabetes anniversary this year, and I’ve been diagnosed with diabetic retinopathy. It’s a long-term complication causing too many small blood vessels to form and begin to leak in the back of the eye. The prospects, if left untreated, are a gradual loss of sight and ultimately blindness. It’s treated by injecting a medication that stops new blood vessels from forming into the eye itself.
It was a slow build-up to the actual diagnosis. My eye doctor was worried about the development in my left eye and referred me to a specialist clinic. A couple of weeks later, I received a letter informing me about the date and itinerary for my visit. At the bottom of the list, they’d included “and possibly an injection” with no further details.
That’s a terrifying nugget of information to receive from an eye clinic. Surely, they couldn’t possibly mean an eye-related injection? That’s not a thing, right? It’s only something that happens in horror movies and after some traumatic eye injury, right?
For a couple of days, I convinced myself that it referred to a regular injection required for a specialized photo they take during the examination. It’s a procedure where you’re injected with a substance that shows up under ultra-violet light. They then take a series of photos of your eye over a couple of minutes where the blood vessels (and any otherwise undetectable leaks) show up like city streets at night seen from up high. (Yes, my urine had a fantastic yellow color that lit up under ultra-violet light for the next two days, thanks for asking.)
But that wasn’t it, was it? That injection wasn’t a faint possibility at the end of the visit. Onto the web to look up more information, and lo and behold: eye-injections are a real thing.
The prospect terrified me. I’m a diabetic, so I’m not afraid of needles. But I’m scared of everything when it comes to my eyes. At the time, I couldn’t even say why exactly what scared me about it. It just sounded unreal.
I had so many questions. How do you remain still while the doctor inserts a needle into your eyeball? How far in does it go? Will I see the needle tip approaching my eye while it’s happening? What if the doctor sneezes during the jab? Isn’t there a United Nations convention or something that classifies this as torture?
I’m sure the doctor has done the procedure many times before, and I’d be in a building full of eye surgeons if anything were to go catastrophically wrong. Yet, I was incredibly stressed out and lived with a fight-or-flight response until the day of the “possible injection”.
I went to the examinations, did all the tests, got my brains blasted out the back of my skull with bright camera flashes, and … nothing. I didn’t need the injection! Instead, I had to come back in three months for another examination. I could go home with nothing but an increased sensitivity to light that would wear off in a few hours.
Three months later, I was stressing out again. My new itinerary didn’t list a “possible injection” this time, but I still worried. At the end of the second examination, the doctor said things hadn’t improved since my first examination. He recommended that I take the injections; once a month for a few months.
He asked how I felt about it. My brain short-circuited, and I couldn’t respond properly with my mind racing. He pressed the issue and strongly recommended I take the injections. My brain still wouldn’t accept the new information, and it took a solid ten minutes before I was at a point where I could say “yes”.
I’m not sure what I was worried about. In retrospect, I was mostly worried about my own reaction and whether I would manage to lay still while someone jabbed a needle into my eye. Secondly, would I see the needle? How could I not see the needle while it was inside of my eye? Yikes.
I still get so stressed by the mere thought that I had to take a break here while writing this. At the time, though, there wasn’t anything concrete that stressed me out. It was just such an alien experience to me, and I didn’t know anything about the procedure other than the part where the needle goes into the eyeball.
The doctor noticed my hesitation and anxiety, and gave me an anti-anxiety pill and some water. Half an hour later, I lay on a bed with a liberal amount of local anesthetic dripped into my eyes. I was trying my best to force my eyes open as the doctor tried in vain to install an eye speculum. The doctor didn’t show me the speculum before trying to install it, and I felt uneasy and frightened by the mere idea of it. I’ve only ever seen devices designed to prevent someone’s eye from closing in torture scenes in movies. There were sound medical reasons for installing it, but that wasn’t a mental priority at the time.
As I lay on the table, the doctor repeatedly asked me to open my eye. I tried my best to comply. My fear of the situation overruled my proprioception. I tried to instruct my eye to open, and I perceived it to be open. Yet, I was seeing the inside of my eyelid. Upon realizing I’d lost control over my eyelids (this is without the speculum), I felt my heart race and I kept forgetting to breathe.
The doctor gave up on the procedure, and I agreed to give it another shot in two weeks. Looking back at this, I’m a bit disappointed that the doctor only wanted to increase my anti-anxiety medication and try again. We definitely should have had a chat about my experience and what we could do to achieve better results next time.
I was stressed out and had problems sleeping for most of the two weeks. I read up on the procedure and the equipment and even steeled myself to watch a video of it. I can’t say this didn’t freak me out or that I was comfortable watching the video. However, I can say that it made me better prepared to go back and try again. The procedure wasn’t this big scary unknown thing anymore. It was just a very unpleasant future prospect that made me very uncomfortable.
In my amateur online research, I came across another video with an eye surgeon discussing how to deal with anxious patients. He suggested gently poking the patient’s eye with a sterile cotton swab and asking if they could see or feel it. “That’s how you’ll experience the injection.” (I can’t find the link, sorry!)
Exposure Therapy 101! I thought this sounded a lot less scary than going straight to jabbing a needle into the eyeball. It would answer the question of whether I’d see the needle or not during the procedure. I made a mental note to ask the doctor to do this for my next visit. It also lowered my stress level as I made a secret plan to abort the procedure if I was freaked out by the cotton swab.
… and then, the next visit went just fine. I showed up and got a doubled dose of anti-anxiety medication. However, I don’t believe that it did as much to calm me as feeling more prepared myself. I’d seen it done, I knew more about what would happen, and I had a plan to warm up with some super-quick exposure therapy.
I told the doctor about the cotton-swab thing, and he agreed to do it. I didn’t use the words “exposure therapy” while describing it, but he muttered it to himself as he went to grab a swab. I was surprised to learn he’d never heard of it before. Maybe most other anxious patients get so relaxed by the anti-anxiety tablets that it isn’t a problem. I guess those don’t work as well on me. In any case, the cotton swab should be part of the standard procedure for new patients.
I felt a lot better about the whole situation going into it. I was given anesthesic drops again, and even that went more smoothly than the last time. We did have a little trouble when he began installing the eye speculum and started giving me instructions for where to look, though.
He wanted me to “look at my shoes”, but I felt a bit panicky at the time, and had to respond that I didn’t know where they were in relation to anything else at that exact time. He suggested I look at the bottom of his surgical mask instead. It took me like a solid ten seconds to seek it out with my eye, but as soon as I did and stopped moving my eyes the speculum was in. Why there wasn’t large brightly colored shapes in the ceiling to look at I’ll never understand.
My heart started racing and I had problems controlling my breath. I couldn’t blink and started to panic. Somehow, I’d not thought about this aspect of the procedure beforehand. I knew it intellectually, but I didn’t realize that not being able to blink would give me a panic. A deep fear about the procedure suddenly crystallized in my mind: I fucking hate bright lights! I lay on my back in a very brightly lit room and couldn’t close my eyes.
I hate sunlight, I hate brightly lit retail stores, and I hate not being able to look away from a bright light source. A 20-minute session under a bright examination light is like the thing I dislike the most about going to the dentist. I use a daylight therapy lamp four months of the year, and I hate every minute of it.
I asked the doctor to hold his hand over my eye to give them some shade and rest. According to my fitness band, my heart rate fell from 140 beats per minute (bpm) to 88 bpm from one measurement to the next about five seconds later. I immediately calmed down and felt greatly relieved.
About half a minute later, he slowly pulled his hand away, and I could more gradually adapt to the lighting. I still wasn’t comfortable with it, but it didn’t cause me to panic anymore.
As we’d discussed, he proceeded to stroke the side of my eye with the cotton swab. I couldn’t feel a thing, and I couldn’t see the damned thing. I felt a lot better about the whole endeavor.
Maybe 20 seconds later, I could see some small bubbles floating upwards in my vision. That was it. That was the injection. Just some tiny bubbles reflecting light in crazy ways. I’d been scared and freaking out on and off over a couple of months over a couple of small bubbles.
I should have been told to stick my hands under my body to keep me from bringing them up to my face. Twice during the procedure, I reflexively started raising my hands to rub my eyes. I stopped myself halfway through the motion, but the nurse got really freaked out by it.
My vision was grayish for a couple of hours. Having gone through this part before, I knew this was a short-lived side-effect of the anesthesia. My eyeball and eyelid felt a bit sore for the next four days. I startled myself a couple of times in the first couple of days as my eye would suddenly hurt as I looked up or down. I guess this is the normal reaction to an unfamiliar feeling of “there’s something wrong with my eye!”
So, this has been a story about overcoming fear with knowledge (and two tablets of anti-anxiety drugs). However, it’s also about poor communication. I’m sure I would have been less anxious and had a better couple of months if the initial letter contained more information. I’m absolutely sure it would have helped if the doctor had volunteered some more specifics about the procedure.
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.
I didn’t have the experience to know what to ask for. One of the few things I did ask about repeatedly was whether I could see the needle going in or not. The doctor who gave me the exams and diagnosis said he didn’t know. The surgeon said I wouldn’t see it approaching as it would come from the side. But he didn’t know if I’d see the actual needle from inside my eye looking out. Instead, he volunteered some technical details about the brand, length, and thickness of the needle itself (not something I asked about).
Frankly, I’m surprised that no one seemed to know the answer to this. Surely other patients must have asked about it? Or commented on it after the procedure? For whatever reason, I was very worried about whether I’d see the needle. I believe this one technical detail about the procedure served as a proxy for how I’d react to it going into my eyeball.
I’m not freaking out about my next injection in three weeks. I can’t say I look forward to it, but I don’t believe I’ll lose any sleep over it either. I’ve conquered the unknown, and discovered it to be nothing but a brief display of bubbles.