Article Text

Download PDFPDF
Lid splinting eyelid retraction technique: a minimised sterile approach for intravitreal injections
  1. Monique Munro1,
  2. Geoff R Williams1,2,
  3. Anna Ells1,2,
  4. Michael Fielden1,2,
  5. Amin Kherani1,2,
  6. Patrick Mitchell1,3,
  7. Jessica Ruzicki4,
  8. Feisal A Adatia1,3
  1. 1 Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
  2. 2 Southern Alberta Eye Center, Calgary, Alberta, Canada
  3. 3 Mitchell Eye Centre, Southern Alberta Eye Center, Calgary, Alberta, Canada
  4. 4 Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada
  1. Correspondence to Dr Feisal A Adatia, Division of Ophthalmology, University of Calgary, Calgary, AB T2T5P8, Canada; fadatia{at}


Background/aims To describe an alternative technique for avoiding contact with the lids and lashes, without the use of a lid speculum, during intravitreal anti-vascular endothelial growth factor injections.

Methods Retrospective case series of all patients undergoing intravitreal injections of bevacizumab and ranibizumab, with the lid splinting retraction technique from January 2010 to December 2015. Injections performed by six vitreoretinal specialists were included. The key preinjection ocular surface preparation includes topical anaesthetic, 5% povidone-iodine and a subconjunctival injection of 2% lidocaine with epinephrine. A second instillation of 5% povidone-iodine is given and the intravitreal injection is then performed. No lid speculum is used. A search of the electronic medical records identified patients diagnosed with postinjection endophthalmitis and charts were reviewed to ensure inclusion criteria were met. The main outcome measure was incidence of postinjection endophthalmitis.

Results A total of 78 009 consecutive intravitreal injections were performed, of which 22 207 were bevacizumab and 55 802 were ranibizumab. In this cohort of patients (n=6320), 12 cases of endophthalmitis developed, corresponding to a rate of 0.015%.

Conclusions The technique of eyelid retraction for intravitreal injection has a low rate of endophthalmitis, similar to the reported rates using a metal lid speculum. This is beneficial for both the physician and the patient as it minimises patient discomfort as well as the duration of the procedure. To our knowledge, this is one of the largest studies performed to date evaluating intravitreal injection-related endophthalmitis.

  • anti-vascular endothelial growth factor intraocular injection
  • endophthalmitis
  • infectious endophthalmitis
  • injection-related endophthalmitis
  • intravitreal injection
  • lid speculum

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AE, MF, AK, PM and GRW aided with protocol development, review of data and manuscript development. MM and FAA contributed to the protocol development, ethics submission, data acquisition and statistics, manuscript development and submission for publication. JR aided with data acquisition and manuscript development.

  • Competing interests None declared.

  • Ethics approval University of Calgary-Calgary Health Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas