Shots in the eye, formally called intravitreal injections, are used to treat a group of serious retinal conditions that threaten your vision. The most common reasons for these injections are wet age-related macular degeneration (wet AMD), diabetic retinopathy, and swelling in the retina caused by blocked blood vessels. The medication is delivered directly into the gel-like fluid inside your eye, where it can reach the retina far more effectively than eye drops or pills ever could.
Conditions These Injections Treat
The National Eye Institute lists four primary conditions treated with eye injections: wet AMD, diabetic retinopathy, diabetic macular edema (and similar swelling from vein blockages in the eye), and ocular histoplasmosis syndrome. All of these conditions involve damage to the retina, the light-sensitive tissue at the back of your eye that sends visual signals to your brain.
Wet AMD is one of the most common reasons people receive these shots. In this condition, abnormal blood vessels grow beneath the retina and leak fluid or blood, distorting your central vision. Diabetic retinopathy works similarly: high blood sugar damages tiny blood vessels in the retina, which can swell, leak, or trigger the growth of fragile new vessels that bleed easily. Retinal vein occlusion, where a vein draining blood from the retina becomes blocked, causes fluid buildup and swelling that also responds to injection treatment.
Steroid injections into the eye treat a slightly different set of problems. They’re used for macular edema from various causes, including diabetes, vein occlusion, inflammation inside the eye (uveitis), and swelling that develops after cataract surgery.
How the Medication Works
Most eye injections deliver a type of drug called an anti-VEGF agent. VEGF is a protein your body naturally produces to grow new blood vessels, but in these retinal diseases, VEGF goes into overdrive. It triggers the growth of abnormal, leaky blood vessels and makes existing vessels more permeable, allowing fluid to seep into the retina. That fluid buildup is what blurs and distorts your vision.
Anti-VEGF drugs bind to this protein and neutralize it. By blocking VEGF, the medication slows or stops abnormal vessel growth and reduces the leaking. As fluid clears from the retina, vision often improves. The first anti-VEGF injection was approved in 2005, and these drugs have since become the standard treatment for several retinal diseases.
Steroid injections work differently. They reduce inflammation broadly, calming swelling in the retina through a different pathway. Doctors typically choose steroids when anti-VEGF drugs haven’t worked well enough on their own, or when inflammation is a major component of the problem.
How Well They Work
For wet AMD, the results are striking. A real-world study of over 1,000 eyes treated with anti-VEGF injections found that vision was stable or improved in 90% of cases. About 63% of treated eyes gained meaningful visual acuity, and 35% gained enough to notice a significant difference in everyday activities like reading. Another 27% maintained stable vision, meaning the disease stopped progressing. These numbers represent a dramatic shift from the era before these injections existed, when wet AMD almost always led to severe central vision loss.
What Happens During the Procedure
The injection itself takes only a few seconds. Your doctor numbs the surface of your eye with anesthetic drops, then cleans the eye and surrounding skin with an antiseptic solution to prevent infection. A very fine needle, typically a 30-gauge (thinner than a standard blood draw needle), is inserted through the white part of the eye into the vitreous cavity, the gel-filled space behind the lens. The medication is injected, and the needle is removed.
Most people feel pressure rather than sharp pain. After the injection, your doctor checks that your vision and eye pressure are normal before sending you home. The whole appointment, including preparation and monitoring, is much longer than the injection itself.
How Often You’ll Need Them
Eye injections aren’t a one-time treatment. Most people start with monthly injections, and the schedule is adjusted based on how the eye responds. Three common approaches exist: fixed monthly dosing, “as needed” dosing (where you get a shot only when signs of disease activity return), and a “treat and extend” approach that gradually stretches the time between injections as long as the eye stays stable.
The treat-and-extend method has become increasingly popular. Compared to monthly injections, patients using this approach needed about 1.6 fewer injections over the first year and nearly 7 fewer over two years. Compared to “as needed” dosing, treat-and-extend required slightly more injections (about 1.4 more per year) but fewer office visits overall, since treatment and monitoring happen at the same appointment. Some patients eventually reach intervals of 12 weeks or longer between shots, while others need them more frequently for years.
Common Side Effects
The most frequent side effects are minor and short-lived. You may notice floating dots, bubbles, or shadows in your vision for a couple of days after the injection. The eye often looks red or bloodshot from a small bleed on the surface of the eye where the needle entered. This can look alarming but resolves on its own and doesn’t affect vision.
Steroid injections carry two additional risks that are worth knowing about. Between 30% and 50% of patients experience a rise in eye pressure within a few months of the injection. This is usually manageable with pressure-lowering eye drops, but it requires monitoring. Cataracts also tend to progress faster in people receiving steroid injections into the eye, though these cataracts can be treated with standard surgery if needed.
Serious Risks
The most feared complication is endophthalmitis, a severe infection inside the eye. This is rare. A large analysis found the rate has declined over time, dropping from about 0.20% of injections in 2000 to 0.05% in 2022, making it the lowest infection rate of any procedure performed inside the eye. The strict antiseptic protocol used before every injection is the main reason the risk stays so low.
Other uncommon complications include retinal detachment (occurring in roughly 0.013% of injections), retinal tears, and short-term spikes in eye pressure. Signs to watch for after an injection include increasing pain, significant vision loss, or new flashes of light, any of which warrant an urgent call to your eye doctor.
Preparing for Your Appointment
If you’re scheduled for an eye injection, bring someone to drive you home. Your vision may be blurry from the numbing drops and dilation, and you may have a small air bubble in your field of vision temporarily. Continue using any prescription eye drops you normally take, ideally from new bottles to minimize infection risk. You can also pick up preservative-free artificial tears from a pharmacy to use afterward for comfort.
Most people find the anticipation worse than the actual experience. The numbing drops are effective, the needle is extremely thin, and the injection is over in seconds. The soreness and grittiness that some people feel afterward typically fades within a day.