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Intravitreal Steroid Injections for Retinal Conditions
Conditions Treated With Intravitreal Steroids
Intravitreal steroid injections are used to treat several serious retinal conditions where inflammation and fluid buildup threaten vision. Our team evaluates each patient individually to determine whether steroid treatment is the right fit, either on its own or alongside other therapies.
Diabetic macular edema (DME) occurs when diabetes-related damage to retinal blood vessels causes fluid to leak into the macula, the part of the retina responsible for sharp central vision. Anti-VEGF injections are typically the first treatment, but when DME does not respond fully, or when a patient has an artificial lens implant, a Retina Specialist may recommend a steroid injection or a sustained-release steroid implant.
A retinal vein occlusion (RVO) happens when a vein carrying blood away from the retina becomes blocked. Fluid backs up and causes swelling in the macula. Steroid injections and implants can reduce the inflammation and fluid buildup that follow a vein occlusion, helping to stabilize or improve vision.
Uveitis is inflammation of the uvea, the middle layer of the eye. When uveitis affects the back of the eye and does not respond to eye drops alone, intravitreal steroids can deliver concentrated anti-inflammatory treatment directly to the area of active disease. This approach is especially helpful for patients with chronic or recurring uveitis.
Our Retina Specialists may also use intravitreal steroids for other ocular inflammatory diseases that do not respond adequately to topical corticosteroid drops. The decision is made based on the specific diagnosis and how well the patient has responded to prior treatments.
Types of Steroid Medications Used
Several steroid formulations are available for intravitreal use, and each has a different duration of action and delivery method. Our team selects the most appropriate option based on the condition being treated, the patient's eye history, and the risk profile for each individual.
Triamcinolone acetonide is the most widely used intravitreal steroid. It has been used for retinal conditions for many years and is available in both standard and preservative-free formulations. Triesence and Trivaris are preservative-free versions that are FDA-approved for ophthalmic use in conditions such as uveitis and other inflammatory eye diseases that have not responded to topical steroids. A single injection typically provides benefit for one to three months.
Ozurdex is a small, biodegradable implant placed inside the eye through a thin applicator. It slowly releases dexamethasone over approximately four to six months, providing sustained anti-inflammatory treatment without the need for monthly injections. Ozurdex is FDA-approved for macular edema related to retinal vein occlusion, for non-infectious uveitis, and for diabetic macular edema.
The implant is made of a solid polymer that gradually breaks down inside the eye, maintaining therapeutic drug levels over an extended period.
Iluvien is a tiny, non-biodegradable implant that continuously releases a low dose of fluocinolone acetonide for two to three years after a single injection. This long-acting option can significantly reduce the number of treatments needed for patients with chronic diabetic macular edema. Because of its extended duration, ongoing monitoring for side effects is essential throughout the treatment period.
A newer delivery method places triamcinolone into the suprachoroidal space, the area between the outer wall of the eye (sclera) and the choroid layer beneath the retina. This approach is FDA-approved for non-infectious uveitis. By placing the medication closer to the back of the eye, suprachoroidal delivery may achieve similar retinal drug levels while potentially causing less pressure elevation and fewer cataracts compared to a traditional intravitreal injection.
Who May Benefit and What to Consider
Not every patient is the right candidate for intravitreal steroid treatment. A thorough evaluation by a Retina Specialist helps determine who is most likely to benefit and who faces a higher risk of side effects. Sharing your full medical and eye history is an important part of this process.
Patients who may benefit from intravitreal steroid treatment include those with diabetic macular edema that has not responded fully to anti-VEGF therapy, those with macular edema from retinal vein occlusion, and individuals with non-infectious uveitis affecting the back of the eye. Patients who already have an artificial lens implant (a condition called being pseudophakic) are often excellent candidates because steroid-induced cataract is not a concern when the natural lens has already been replaced.
Certain patients have a greater chance of experiencing side effects. Those with primary open-angle glaucoma (POAG), a condition where increased eye pressure damages the optic nerve, or those with a close family member with POAG, are more likely to experience steroid-related pressure increases. Other risk factors include high myopia (severe nearsightedness), connective tissue disease, type 1 diabetes, and a personal history of elevated eye pressure after prior steroid use.
Before recommending a steroid injection, a Retina Specialist will carefully review your eye pressure history, lens status, glaucoma risk factors, and how you have responded to previous treatments. This evaluation helps identify the safest and most effective steroid formulation and delivery method for your specific situation.
What Happens During the Procedure
Intravitreal steroid injections are performed in the office and take only a few minutes from start to finish. The procedure is carefully designed to be as comfortable as possible, and most patients return to normal activities the same day.
The eye is numbed with anesthetic drops or a small injection of local anesthetic around the eye. The skin around the eye and the eye surface are cleaned with an antiseptic solution, usually povidone-iodine, to reduce the risk of infection. A small device called a speculum may be placed to gently hold the eyelids open during the procedure.
A Retina Specialist uses a very thin needle to inject the steroid through the white part of the eye, called the sclera, into the vitreous cavity inside the eye. The injection itself takes only a few seconds. For implant-based treatments such as Ozurdex, a small applicator is used to place the implant inside the eye. Most patients feel pressure during the injection rather than sharp pain, and the numbing medication helps minimize discomfort.
After the injection, the Retina Specialist may check your eye pressure and briefly examine the eye. You may notice temporary blurred vision, mild redness, or a sensation of something in the eye. With triamcinolone injections, small white particles from the drug suspension may appear as floaters for a few days before settling and dissolving. These are expected and typically resolve on their own.
Possible Side Effects and Complications
Intravitreal steroid injections are generally well tolerated, but like all medical treatments they carry potential side effects. Understanding these risks helps patients and their Retina Specialist make informed decisions together.
The most common side effect of intravitreal steroids is elevated intraocular pressure (IOP), which means pressure inside the eye rises above the normal range. This occurs in a meaningful portion of patients, and the risk increases with higher steroid doses. In most cases, elevated pressure is temporary and can be managed with one or more glaucoma eye drops. In rare situations, a minor procedure may be needed to protect the optic nerve if drops alone are not sufficient.
Steroid use in the eye can speed up cataract development in patients who still have their natural lens. A cataract is a clouding of the natural lens that causes vision to become hazy or blurred. This is an important consideration for patients who have not yet had cataract surgery. Patients who already have an artificial lens implant do not face this risk.
Endophthalmitis is a serious infection inside the eye that can occur after any intravitreal injection. While this complication is rare, it is potentially vision-threatening. Strict sterile technique during the procedure helps minimize this risk. Symptoms to watch for include increasing eye pain, worsening vision, and growing redness in the days following the injection. These symptoms require prompt evaluation.
Less common complications include retinal detachment, vitreous hemorrhage (bleeding inside the eye), and migration of a steroid implant toward the front of the eye. While these events are rare, they may require additional treatment or surgery. Knowing the warning signs and contacting your Retina Specialist promptly helps protect your outcome.
Living With Steroid Injection Treatment
For many retinal conditions, steroid injections are part of an ongoing treatment plan rather than a single event. Regular monitoring and clear communication with your Retina Specialist are key to keeping side effects manageable and protecting your vision over time.
Follow-up visits are essential after an intravitreal steroid injection. Your Retina Specialist will check eye pressure, monitor for cataract progression, and assess whether the swelling in the retina has improved. A follow-up visit typically occurs within one to two weeks after the injection and then at regular intervals. Patients with long-acting implants such as Iluvien may need ongoing monitoring for the full duration of the implant, which can be two to three years.
Many retinal conditions are chronic and may require more than one steroid injection over time. Sustained-release implants can help reduce the frequency of repeat treatments. Your Retina Specialist will adjust your treatment plan based on how your eye responds and will make changes if side effects such as elevated pressure or progressive cataract become a concern.
Most patients can resume normal activities the same day or the day after the injection. Your Retina Specialist may recommend avoiding rubbing the eye, swimming, or heavy lifting for a short period after treatment. Using any prescribed eye drops exactly as directed helps prevent infection and keep pressure under control. Patients with diabetes should continue to manage blood sugar levels, since good systemic control supports overall eye health.
It is important to know which symptoms require urgent attention after an intravitreal steroid injection. Contact your Retina Specialist right away or go to an emergency room if you experience any of the following:
- Sudden decrease in vision or sudden vision loss
- Increasing eye pain that does not improve
- Significant increase in redness of the eye
- New flashes of light or a sudden increase in floaters
- A shadow or curtain appearing over any part of your vision
Early treatment of complications such as infection or retinal detachment leads to significantly better outcomes.
Frequently Asked Questions
Below are answers to questions our patients commonly ask about intravitreal steroid injections. These answers are meant to guide your thinking and help you prepare for a conversation with your Retina Specialist.
Duration varies by formulation, and the right choice depends on your condition, your eye's response, and your risk profile. Shorter-acting options like triamcinolone acetonide injections may allow a Retina Specialist to pause treatment more easily if side effects develop, while longer-acting implants reduce the burden of frequent office visits. If you are newer to steroid treatment or have higher risk factors for pressure or cataract, starting with a shorter-acting option may give your care team more flexibility to adjust the plan.
Having glaucoma does not automatically rule out steroid treatment, but it does require careful planning. Patients with primary open-angle glaucoma have a significantly higher likelihood of experiencing steroid-induced pressure elevation than the general population. In these cases, a Retina Specialist will weigh the benefit of reducing retinal swelling against the added pressure risk, may choose the lowest effective steroid dose, and will monitor eye pressure closely. Some patients with glaucoma are managed successfully with intravitreal steroids alongside their existing glaucoma treatment.
Yes, combining steroid and anti-VEGF therapy is an established approach for certain patients. Because the two medication types target different parts of the disease process, they can complement each other. A patient with diabetic macular edema who has not responded fully to anti-VEGF agents such as Eylea or Vabysmo may benefit from adding a steroid injection or implant. The combination is planned by your Retina Specialist based on your specific disease activity and treatment history.
Some temporary blurring or visual disturbance immediately after injection is normal, especially with triamcinolone, which can cause visible particles in the eye for a short time. However, if your vision is getting noticeably worse rather than settling, or if you develop increasing pain or redness, you should contact your Retina Specialist the same day rather than waiting for your next scheduled visit. These symptoms could indicate an elevation in eye pressure or, in rare cases, an infection, both of which respond better to early treatment.
In the vast majority of cases, steroid-induced pressure elevation is temporary and resolves as the medication wears off. However, in a small number of patients, particularly those with an underlying susceptibility to glaucoma, the pressure may remain elevated and require ongoing management. This is one reason why follow-up visits are so important. If pressure remains elevated, your Retina Specialist may continue glaucoma eye drops, adjust your steroid treatment plan, or refer you for a glaucoma evaluation to protect the optic nerve.
The most effective step you can take is to attend every follow-up appointment so that pressure changes or lens changes are caught early. Taking any prescribed eye drops exactly as directed and reporting new symptoms promptly also make a significant difference. For patients with diabetes, keeping blood sugar well controlled supports better healing and reduces the baseline level of retinal inflammation. Your Retina Specialist will factor in your full health picture when choosing the steroid formulation least likely to cause problems for you specifically.
Visit Atlantic Retina Center
Our team of vitreoretinal fellowship-trained, board-certified Retina Specialists is dedicated exclusively to the care of the retina, vitreous, and macula, bringing specialized expertise to every patient we see across the Eastern Shore of Maryland and central and southern Delaware. If you have been told you may need a steroid injection, or if your current treatment is not controlling your retinal condition as well as expected, we are here to help you understand your options. We look forward to partnering with you to protect and preserve your vision for the long term.