Tal Yahalomi, Idan Hecht, Oded Lagstein, Achia Nemet, Liron Pe’Er, Fady Hadad, Ari Keren-Yaar, Rabea Kassem, Zvia Burgansky-Eliash, Asaf Bar, Asaf Achiron

Research output: Contribution to journalArticlepeer-review


Purpose: Intravitreal injections of intraocular therapeutic agents are a common and effective treatment for various retinal pathologies. Patient discomfort related to injection is a potential barrier to treatment. Our aim in this study was to evaluate whether cooling the eye using topical ice compresses before intravitreal injection will reduce pain or bleeding. Methods: This randomized controlled open-label study included 42 patients. All patients received a standard topical anesthesia protocol and then were randomly assigned to either receive a placement of ice packs (intervention group) or a room-temperature pack (control group) on the eyelid, 2 minutes before the intravitreal injection. Patients’ discomfort, itching, burning and pain (using visual analog scale), and bleeding size (using photographs) were measured 1 and 10 minutes after the injection. Tolerability was calculated by averaging patients’ discomfort, itching, burning, and pain scores. Results: At 1 minute, pain (1.95 vs. 4.27, P = 0.01) and overall tolerability (1.66 vs. 2.98, P = 0.03) were significantly lower in patients receiving ice packs. At 10 minutes, pain (1.6 vs. 3.73, P = 0.02), burning (0.9 vs. 3.09, P = 0.007), discomfort (2.1 vs. 4.27, P = 0.008), and overall tolerability (1.23 vs. 2.87, P = 0.004) were all significantly lower in the ice group compared with the controls. Bleeding size (area or circumference) was not statistical different between groups. Conclusion: Topical ice patch administered before intravitreal injection significantly decreased pain and overall tolerability. This simple and inexpensive method may be used to ameliorated pain and improve tolerability.

Original languageEnglish
Pages (from-to)1434-1438
Number of pages5
Issue number7
StatePublished - 1 Jul 2020


  • Age-related macular degeneration
  • Central retinal vein occlusion
  • Diabetic macular edema
  • Intravitreous injection
  • Pain


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