Do I Need Numbing Drops or a Numbing Shot Before My Eye Injection?
Numbing Choices for an Eye Injection at a Glance
Drops are usually enough. When the pooled studies are put side by side, numbing drops gave pain relief no different from numbing gel or a numbing shot under the surface of the eye, and no different on burning or on how satisfied patients were afterward.1 A separate review of 12 studies reached the same place: no numbing method came out ahead of the others.2 So this is not a choice between comfort and discomfort. It is a choice between two routes to about the same result, and most clinics start with drops.
Waiting for an eye injection tends to make every detail feel enormous, including which numbing your clinic uses. Across 8 randomized trials covering 847 patients, pain during the injection was mild whatever the numbing technique, sitting in the mild band of a 100-point scale.3 Mild is not nothing, and you are allowed to dislike it. But the gap between the methods is small enough that your clinic's routine, your eye's history and your own preference all reasonably outweigh it.
This page explains the options and what the research shows. It cannot tell you which numbing suits your eye, and it is not a reason to argue with a clinic that has a settled routine. Expert guidance treats topical numbing as usually necessary, with an added shot as an option rather than a requirement.4 If the last injection was uncomfortable, that is worth saying out loud before the next one, which is a conversation rather than a decision you make alone.
What Each Numbing Method Actually Involves
Topical numbing means the medicine sits on the surface of your eye rather than going under it. Drops of proparacaine or tetracaine sting briefly, then the surface goes numb within a minute or two. Gel is thicker and stays in place longer. A pledget is a small cotton pad soaked in numbing medicine and tucked against the white of the eye for a few minutes. All three are topical routes, and reviews group them together because they perform much alike.2
A subconjunctival shot puts numbing medicine, usually lidocaine, just under the clear skin covering the white of the eye. It is given with a very fine needle after drops have already numbed the surface, so the shot itself is usually felt as pressure rather than a jab. It numbs a deeper and more definite patch. Guidance describes it as an addition to topical numbing, not a replacement for it.4
Numbing is only part of what happens to your eye in those few minutes. The Academy describes the visit as cleaning the eye to prevent infection, numbing it, sometimes placing a small holder to keep the lids open, then injecting through the white of the eye with a very thin needle in a procedure lasting seconds.5 Povidone-iodine antiseptic should be the last thing applied before the needle, and when gel is used it goes on both before and after the gel.4
Drops Versus a Numbing Shot, Side by Side
The table sets out the practical differences. The pain column is the one people expect to be decisive, and it is the one where the two methods land closest together.
| What matters | Drops, gel or pledget | Numbing shot |
|---|---|---|
| Pain during the injection | Mild | Mild, and not reliably lower |
| Discomfort from the numbing itself | Brief sting | An extra needle and pressure |
| Time added to the visit | Adds the least | Adds a few minutes more |
| Red blood spot on the white of the eye | Not reported | Common |
| Depth of numbing | Surface | Deeper, more definite |
The pooled comparison found no significant difference in post-injection pain between drops and either gel or a subconjunctival shot.1 The blood-spot difference is real: in one study within a systematic review, 9 of 28 eyes given a subconjunctival numbing shot developed a red patch, while none of the eyes given topical numbing did.2
Two randomized trials are worth knowing about. In one masked trial, 24 patients each received four injections under a different numbing method, and the combined scores for numbing plus injection came out at 3.5 out of 10 for proparacaine drops, 3.8 for a subconjunctival shot, 4.1 for tetracaine drops and 4.4 for a pledget, a spread that was not statistically significant, while the shot produced the most side effects.6 In a later crossover trial of 60 patients, adding a numbing-soaked pledget on top of drops did not reduce pain compared with a dummy pledget.7
Drops suit most people, and they suit the routine visit particularly well: quick, no extra needle, no red patch to explain to family afterward. Clinics differ on when they add a shot, and the reasons usually given are a previous injection that was genuinely painful rather than merely unpleasant, an eye that is hard to keep still, or a longer procedure. Since neither route is clearly better on pain, the sensible tiebreakers are your own experience and your clinic's practice.2
How Much the Injection Itself Actually Hurts
Numbers help more than reassurance here, because they set an expectation you can check against. Reported pain scores across trials of topical numbing ran from roughly 1 to 45 on a 100-point scale, which stays inside the mild band.3 In the studies that used a 0 to 10 scale, scores clustered between about 1.4 and 4.4.2 Most people describe pressure and a brief sting rather than a sharp pain. Some feel almost nothing. If yours was worse than that, it is worth reporting rather than enduring.
Several things may move the number, and the numbing method is only one of them. In one study within a systematic review, a thinner 30-gauge needle caused less pain than a thicker 26-gauge one.3 The same review describes a single study that linked pain to vision that had improved since the last injection, to being female, to being over 65, and to the number of injections already given, and a second study that did not confirm those links, so those patient factors are unsettled rather than established.3 Discomfort in the hours after an injection can also come from the anesthetic drops, the dilating drops, the lidocaine gel or the antiseptic irritating the surface, separately from the needle.3 That last point is worth knowing: if your eye stings for hours afterward, the drops are one likely reason, and your team can adjust them.
The first injection carries the weight of not knowing what happens, and people reasonably ask whether it stays that way. The honest answer is that the published work is split. One study within the review found pain scores decreasing with each consecutive injection, while a second study did not confirm that pattern.3 So some people settle into the routine and some do not, and neither experience means something has gone wrong. If your first was the worst so far, that is a familiar story. If yours has not eased, say so at the next visit rather than assuming it should have.
Risks, Trade-Offs, and What to Expect Afterward
The most common trade-off of a numbing shot is cosmetic rather than dangerous. A subconjunctival shot can leave a bright red patch on the white of the eye, which was the main adverse effect identified across the review, and it was not seen with topical numbing.2 The patch looks alarming and does not hurt. It fades over a week or two, much like a bruise. Tell people it is a bruise, because that is what it is.
Whichever numbing you have, the eye usually feels scratchy for a few hours once it wears off, and it may water or look pink. That comes partly from the antiseptic and partly from the drops used to keep the lids open. Preservative-free artificial tears help, and so does not rubbing. Vision is often blurry for a while from the antiseptic and the medicine itself. Arrange a ride home for the first injection until you know how yours goes.
This risk belongs to the injection, not to the numbing choice, and it is small. Pooled across 43 studies, infection inside the eye followed 197 of 350,535 injections, about 6 of every 10,000, so roughly 1 injection in 1,800.8 Rare is not never, and that is why the warning signs below matter. Antibiotic drops before, during or after the injection are not recommended, because the evidence has not shown they lower this risk.4 The antiseptic step is what does the work.
When to Call Your Eye Doctor After an Injection
Call your eye clinic the same day, or use its out-of-hours number, if any of these appear in the days after an injection.
- Pain that gets worse instead of better, especially after the first day
- Vision that drops or blurs more than it did right after the injection
- Growing redness, light sensitivity, or discharge
- A shower of new floaters, flashing lights, or a shadow across your sight
Infection inside the eye is uncommon, at about 6 of every 10,000 injections in the pooled data.8 These are the signs that clinics look at the same day rather than at your next scheduled visit. Most people who call turn out to have ordinary soreness. That is a good outcome, not a wasted call.
A gritty, scratchy feeling for a few hours is expected. So is a red spot where the needle went in, watering, mild ache, and vision that is hazy for the rest of the day. These settle. The pattern that distinguishes normal from worrying is direction: ordinary soreness improves each day, while a problem gets worse rather than better. If you are unsure which one you are having, call and describe it.
Say it plainly at the start of the visit, not afterward: tell them the last injection hurt, where it hurt, and at what moment. Clinics can extend the numbing time, add a pledget or a shot, use a smaller needle, or change the order of the antiseptic. Since no method is clearly superior, adjusting the approach for a specific patient is reasonable rather than unusual.2 Nobody will think less of you for asking.
Questions People Ask About Numbing for Eye Injections
Usually you feel pressure rather than a sharp jab, and many people feel very little. The Academy notes that patients usually do not see the needle, and the injection itself takes only a few seconds.5 Your eyelids are usually held open with a small clip, which many people find odder than the injection itself. Looking away from the injection site gives you something to do and keeps the eye steady.
It numbs a deeper and more defined area, but that has not translated into meaningfully less pain in the studies. Pooled data found no significant difference in post-injection pain between drops and a subconjunctival shot.1 In a randomized trial, the shot scored 3.8 out of 10 against 3.5 for proparacaine drops, a difference well inside chance.6 Stronger numbing and less remembered pain are not the same thing.
Often the antiseptic rather than the needle. Povidone-iodine and the dilating drops are named as real sources of discomfort in the review of injection pain, separate from the injection.3 The antiseptic has to be the last thing applied before the needle, so it cannot simply be moved earlier to spare you the sting.4 Extra numbing drops after it can help, so mention the sting to your team.
You can ask, and many clinics use it. Gel performed about the same as drops on pain and satisfaction in the pooled analysis.1 The early worry that gel might blunt the antiseptic came from a laboratory dish experiment, and a later study of infection rates after injection found no significant difference in infection whether the gel went on before or after the antiseptic.2 The guideline answer is to apply the antiseptic both before and after the gel.4 Availability and clinic routine usually decide it.
Probably not for most people. In a crossover trial of 60 patients, adding a numbing-soaked pledget to drops did not lower pain compared with a dummy pledget, with scores of 2.80 against 2.51 on a 10-centimeter scale straight after the injection.7 A pledget also scored no better than drops in the earlier four-arm trial.6 It is a reasonable thing to try if drops alone have not been enough for you.
More Questions About Comfort During Eye Injections
For a routine injection this is very rarely offered, because the procedure takes seconds and the recovery from sedation would take far longer than the treatment. Sedation carries its own risks, and injections are usually needed repeatedly over months or years. If anxiety rather than pain is the real problem, say so, because the useful answers there are different: a longer appointment slot, someone to talk you through it, or a break between eyes.
Usually yes, and that is when the eye tends to feel grittiest. Surface numbing does not last long, so the scratchy phase often starts on the journey home. Do not rub the eye while it is still numb, since you cannot feel what you are doing to the surface. Preservative-free artificial tears and a quiet evening cover most of it.
There is no known effect. Numbing acts on the surface tissue and the medicine acts inside the eye, so they are not expected to interact in a way that changes the treatment. The guideline concern about anesthetic gel was about antiseptic contact, not about the injected medicine, and the recommended fix is antiseptic before and after the gel.4 How well your treatment works depends on your condition and your schedule of injections.
It is a common experience, and it is not a sign that anything went wrong. One study in the review found pain scores falling with each consecutive injection, though a second study did not find that link, so later injections may or may not feel easier for you.3 The first one carries the anticipation, the unfamiliar lid holder and the surprise of the antiseptic. Tell your team exactly what was worst, because the fixes differ: a longer numbing wait, extra drops after the antiseptic, a smaller needle, or a shot next time.
Bring this list to your next injection appointment and ask before the drops go in.
- What numbing does this clinic use as standard, and why that one?
- Can we allow more time for the numbing to work before the injection?
- If the antiseptic is what stings, can I have extra drops after it?
- What needle size do you use for my injections?
- If I found the last one painful, what would you change this time?
- Which number should I call if my eye gets more painful tonight?
- Alhazimi A. Frontiers in Medicine (2026). The safety and effectiveness of anesthetic drops for intravitreal drug administration: a meta-analysis.
- Han J, Rinella NT, Chao DL. Clinical Ophthalmology (2020). Anesthesia for Intravitreal Injection: A Systematic Review.
- Shiroma HF, Takaschima AKK, Farah ME, Hofling-Lima AL, de Luca Canto G, Benedetti RH, Rodrigues EB. International Journal of Retina and Vitreous (2017). Patient pain during intravitreal injections under topical anesthesia: a systematic review.
- Avery RL, et al. Retina (2014). Intravitreal injection technique and monitoring: updated guidelines of an expert panel.
- American Academy of Ophthalmology, EyeSmart (2024). Anti-VEGF Treatments.
- Blaha GR, Tilton EP, Barouch FC, Marx JL. Retina (2011). Randomized trial of anesthetic methods for intravitreal injections.
- Lo JMY, Li VYY, Cheung RKY, Chow SC, Shih KC, Fung NSK, Lam WC. International Journal of Retina and Vitreous (2025). Comparison of different topical anesthetic methods for intravitreal injections: a randomized crossover study.
- Fileta JB, Scott IU, Flynn HW. Ophthalmic Surgery, Lasers and Imaging Retina (2014). Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.