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Effect of topical 5% phenylephrine in reducing the incidence of subconjunctival hemorrhage after intravitreal injection

Hind Ahmed Yousif
Department of Ophthalmology, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
Ahmed Ismail Abdulgani
Department of Ophthalmology, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
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Copyright (c) 2026 Hind Ahmed Yousif , Ahmed Ismail Abdulgani (Author)

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Abstract

Background and objective: Subconjunctival hemorrhage (SCH) is a common condition; one of its important causes is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), which is used to treat various ocular pathologies. In this study, we aimed to decrease subconjunctival hemorrhage with the use of a 5% phenylephrine hydrochloride topical drop.

Methods: Prospective, randomized, single-blind, multicenter study. One hundred patients (116 eyes) with different retinal pathologies were enrolled, divided into two groups: group 1, 50 patients (60 eyes), received one drop of phenylephrine, and group 2, 50 patients (56 eyes), received a drop of distilled water, fifteen minutes before intravitreal injection. Patients were examined by slit lamp for presence of subconjunctival hemorrhage 24 hours after the injection.

Results: The frequency of subconjunctival hemorrhage in the intervention group was 23.3% (14 of 60 eyes), notably less (p=0.041) than in the control group (41.1%, 23 of 56 eyes).

Conclusion: Administration of topical phenylephrine hydrochloride 5%, 15 minutes prior to intravitreal injection of anti-VEGF, appears to be an effective and straightforward approach for reducing or preventing subconjunctival hemorrhage (SCH) — a commonly reported complication following such injections. This strategy may contribute to improved patient comfort and compliance with ongoing intravitreal therapy.

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How to Cite
Ahmed Yousif , H. ., & Ismail Abdulgani, A. . (2026). Effect of topical 5% phenylephrine in reducing the incidence of subconjunctival hemorrhage after intravitreal injection. Zanco Journal of Medical Sciences (ZJMS), 822–830. https://doi.org/10.15218/zjms.2026.059

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