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Antiseptic — Pre-Injection Prophylaxis / Adenoviral Conjunctivitis Pregnancy: Use with caution — avoid prolonged use; single-dose pre-injection use considered acceptable; potential iodine uptake by fetal thyroid with repeated use

Povidone-Iodine 5% Ophthalmic Solution

Brand names: Betadine Ophthalmic, Minims Povidone-Iodine

Adult dose

Dose: Pre-intravitreal injection: 1 drop 5% PVP-I instilled 2–3 minutes before injection; Adenoviral conjunctivitis (off-label): 2 drops 0.8–2% four times daily for 5 days
Route: Topical ophthalmic
Frequency: Single dose pre-injection; or four times daily for conjunctivitis
Max: As per indication; pre-injection use is single dose
Most important use: mandatory pre-intravitreal injection antisepsis — reduces endophthalmitis risk; allow 2–3 minutes contact time before injection; available as single-use units for aseptic administration

Paediatric dose

Route: Topical
Frequency: As per indication
Max: As per adult dose
Used in paediatric intravitreal injection settings and neonatal conjunctivitis prophylaxis (where available)

Dose adjustments

Renal

No adjustment required (negligible systemic absorption — avoid excessive or prolonged use in renal failure)

Hepatic

No adjustment required

Clinical pearls

  • Standard of care for intravitreal injection antisepsis: NICE TA155, RCOphth guidelines, and BSR all specify PVP-I 5% as mandatory pre-injection antisepsis — reduces post-injection endophthalmitis rate from ~0.3% to ~0.03%; do NOT substitute with chlorhexidine (corneal toxicity risk at concentrations effective against bacteria)
  • Adenoviral conjunctivitis: epidemic keratoconjunctivitis (EKC) caused by adenovirus — no licensed antiviral; PVP-I 0.8–2% (diluted from 5%) has virucidal activity demonstrated in multiple studies; used off-label by specialist ophthalmologists to reduce viral load and duration; reduces risk of subepithelial infiltrates
  • Contact time matters: minimum 2–3 minutes contact time required before intravitreal needle insertion — insufficient contact time (less than 30 seconds) provides incomplete antisepsis; most endophthalmitis cases post-intravitreal injection occur from lid/conjunctival flora
  • Iodine allergy: true iodine allergy is rare; 'shellfish allergy' does NOT predict iodine hypersensitivity (shellfish allergy is to specific proteins, not iodine); however formal iodine allergy history warrants caution — consider alternative surgical skin prep and discuss with anaesthetic team
  • Neonatal conjunctivitis prophylaxis: in resource-limited settings, PVP-I 2.5% is WHO-recommended alternative to erythromycin/tetracycline ointment for prevention of neonatal ophthalmia neonatorum (N. gonorrhoeae, C. trachomatis) — lower cost, broader spectrum

Contraindications

  • Iodine hypersensitivity
  • Active thyroid disease (significant iodine absorption with prolonged use)
  • Concurrent use with silver-containing preparations (incompatible)

Side effects

  • Transient burning or stinging
  • Superficial punctate keratopathy (transient)
  • Rare: iodine hypersensitivity reaction
  • Thyroid function changes with prolonged use (rare at ophthalmic concentrations)

Interactions

  • Silver-based compounds (e.g. silver nitrate) — precipitate together; do not use concurrently
  • Mercury-based antiseptics — incompatible

Monitoring

  • No specific monitoring for single-dose pre-injection use
  • Thyroid function if prolonged high-frequency use
  • Signs of hypersensitivity

Reference: BNFc; BNF 90; RCOphth Intravitreal Injection Guidelines 2023; NICE TA155; SPC Betadine Ophthalmic; Tabatabaei et al. Cornea 2019 (EKC). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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