What are some methods to deal with IOP elevations with intravitreal injections in a patient without glaucomatous damage that does not want to have AC taps with each injection?

In this situation, depending on the elevated IOP, use the standard medical approach: Iopidine1%, Cosopt, Alphagan 0.2%, and in some cases, Diamox 250 mg. Wait for half an hour and repeat if necessary, or send the patient home with one or more drugs. Of course, make sure of drug selective contraindic...

I have to admit this is not something I encounter very often in my practice. In the rare situations where I have seen significant IOP elevations with intravitreal injections in patients without underlying glaucomatous damage, I typically don't need to perform routine anterior chamber taps.

I did ask...

What everyone wants is an 'instantaneous cure'... other than paracentesis, this is pharmacodynamics and a pressure/volume problem. Treat with 'Glaucoma' drops and or Diamox 1/2 hour before, when the patient is being started by the tech (patients wait anyway), and let the medicine work. When it happe...

In someone with previous spikes, Combigan 20 minutes prior works great.

For everyone else who randomly gets a spike, ocular massage after will quickly lower.

I have used a Honan cuff on several patients. It works well.

Addendum: June 11, 2026

Sitting the patient upright after the injection sometimes causes the IOP to rise. In those cases, I leave the patient supine until the vision returns or the IOP decreases.

Although not common, IOP can spike dramatically (over 50) with injections. In these situations, drops don’t work well. Patient that has an IOP spike usually spikes every time.

Has anyone tried ocular massage in these situations? I have tried it once, and it worked.