Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antiseptic — Pre-Injection Prophylaxis / Adenoviral Conjunctivitis Pregnancy: §4.6: 'Minims Povidone Iodine 5% w/v eye drops, solution can be used during pregnancy.' Animal studies have shown no teratogenic effects and 'No effects during pregnancy are anticipated, since systemic exposure to iodine is negligible.' The SPC notes that relevant clinical data are not sufficiently available to assess malformation risk in the first trimester, and that 'The foetal thyroid begins to accumulate iodine around the 14th week of amenorrhoea.' It adds: 'In pregnant or breastfeeding women an alternative form of antisepsis should be considered if multiple repeat injections requiring conjunctival and periorbital application are anticipated.' Breast-feeding: no effects on the breastfed infant are anticipated, systemic exposure being negligible. Fertility: no effects anticipated.

Povidone-Iodine 5% Ophthalmic Solution

Brand names: Betadine Ophthalmic, Minims Povidone-Iodine

Povidone-iodine 5% ophthalmic solution is a broad-spectrum antiseptic used for ocular surface antisepsis, most importantly to prepare the conjunctiva and periocular skin before intraocular surgery and intravitreal injection to reduce the risk of endophthalmitis.

Adult dose

Dose: Pre-procedural ocular surface antisepsis (this is the ONLY use the SPC supports — see scope note): instil 2 to 3 drops of povidone-iodine 5% w/v onto the eye / eyes and leave in contact for two minutes, then irrigate thoroughly with sterile saline 0.9% w/v until the characteristic colour of the iodine solution disappears. §4.2 verbatim: 'Adults (including the elderly) Instill 2 to 3 drops of the solution onto the eye / eyes and leave for two minutes.'
Route: Topical ophthalmic, to the cutaneous-conjunctival surface only. §4.4: 'For ophthalmic use only.' §4.3: the product 'is contraindicated for intra-ocular or peri-ocular injection' — it is applied to the eye surface before a procedure, never injected.
Frequency: Single pre-procedural application. §4.2 describes one instillation followed by saline irrigation and states no repeat-dose frequency. §4.4 warns that 'Repeated applications of povidone-iodine to ocular surface related to long term ophthalmic therapy with intravitreal injections may result in tear film abnormalities or aggravate existing tear film abnormalities.'
The SPC supports antisepsis before intravitreal injection: §4.4 and §4.6 both discuss its use in the context of intravitreal injection therapy. ⚠️ THE ADENOVIRAL CONJUNCTIVITIS HALF OF THIS PAGE IS NOT SOURCED AND IS EXPLICITLY OUTSIDE THIS PRODUCT'S LICENCE. §4.4 verbatim: 'There is no experience of ocular instillation, other than for pre-procedural antisepsis. The use of Minims Povidone Iodine 5% w/v eye drops, solution is restricted to cutaneous-conjunctival surface antisepsis ONLY.' A source for that use would have to be a product licensed for it, or a named clinical guideline, and it should be labelled off-label on the page. The SPC figures are published. MANDATORY POST-APPLICATION STEP — §4.4 verbatim: 'After the medicinal product has been left in contact with the conjunctiva and conjunctival sacs for two minutes, flush thoroughly with sterile 0.9 % NaCL solution.' Full §4.2 method: wash hands thoroughly before use; clean the area around the eyes with a sterile cotton swab; twist off the cap of the single-dose container; do not touch the eye with the container nozzle; instil the drops gently; ask the patient to close and roll their eyes to spread the solution; leave two minutes; then irrigate with sterile saline 0.9% w/v using a suitable syringe until the iodine colour disappears.

Paediatric dose

Route: Topical ophthalmic
Frequency: Single pre-procedural application, as for adults
Max: As per the adult dose — no separate paediatric ceiling is stated
The label's own paediatric statement, §4.2 verbatim: 'Paediatric population The adult dose may be used in infants, children and adolescents.' So 2 to 3 drops instilled and left for two minutes, then irrigated with sterile saline 0.9% w/v, applies unchanged. This is a topical drop count, not a weight-based dose — there is no mg/kg figure and none has been derived. ⚠️ CONTRAINDICATED IN PRE-TERM INFANTS — §4.3 lists 'In pre-term infants' as an absolute contraindication. §4.8 adds that 'Regular and prolonged application may lead to toxic levels of iodine likely to develop abnormal thyroid function, particularly in pre-term infants and neonates.'

Dose adjustments

Renal

No renal dose adjustment is stated in this SPC. §4.6 notes that 'systemic exposure to iodine is negligible' after ocular instillation.

Hepatic

No hepatic dose adjustment is stated in this SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • §4.3 verbatim: 'Hypersensitivity to iodinated povidone, to iodine or to any of the excipients listed in section 6.1.'
  • §4.3 verbatim: 'In pre-term infants.'
  • §4.3 verbatim: 'Minims Povidone Iodine 5% w/v eye drops, solution is contraindicated for intra-ocular or peri-ocular injection.'
  • Not a contraindication — §4.4 states explicitly that hypersensitivity (anaphylactoid reactions) to iodinated contrast agents, and anaphylactic reaction to shellfish, 'are not contraindications for Minims Povidone Iodine 5% w/v eye drops administration'.

Side effects

  • Immune system (§4.8, frequency not known): hypersensitivity and anaphylactic reactions — urticaria, Quincke's oedema, anaphylactic shock and anaphylactoid reaction. §4.8 identifies hypersensitivity as 'the most serious adverse reaction'.
  • Endocrine (§4.8, frequency not known): 'Regular and prolonged application may lead to toxic levels of iodine likely to develop abnormal thyroid function, particularly in pre-term infants and neonates. Exceptional cases of hypothyroidism have been reported.'
  • Eye (§4.8, frequency not known): conjunctival hyperaemia, superficial punctate keratitis, eye irritation, superficial punctate epitheliopathy, keratoconjunctivitis sicca, residual yellow coloration of the conjunctiva
  • Eye (§4.8): 'Cases of corneal calcification have been reported very rarely in association with the use of phosphate containing eye drops in some patients with significantly damaged corneas.'
  • Skin (§4.8, frequency not known): contact dermatitis (erythema, blisters, itching), angioedema, and reversible transient brown coloration of the skin
  • Tear film (§4.4): repeated application in the context of long-term intravitreal injection therapy may cause or aggravate tear film abnormalities

Interactions

  • §4.5: 'Concomitant or subsequent use with other antiseptic agents should be avoided, because of the potential for interference (antagonism, inactivation).'
  • §4.5: mercury-based derivatives — 'the combination iodine/mercury-based preservatives must be avoided, due to the risk of caustic compounds formation. Particularly, special care must be taken in relation to the mercurial preservatives used in many ophthalmic preparations.' §4.4 repeats this as a precaution.
  • §4.5: 'When administered at volumes greater than those arising from single ocular instillation, povidone iodine may interfere with thyroid function tests.'
  • §4.5: 'Cross-reactions with iodinated contrast agents have not been reported.'

Monitoring

  • Use with caution in patients with thyroid dysfunction and in elderly patients, who are at increased risk of developing thyroid dysfunction; §4.4 advises that 'Monitoring of thyroid function should be considered, particularly during regular repeated use of the medicinal product.'
  • Monitor patients with dry eye syndrome for exacerbation, and treat appropriately, where repeated application accompanies long-term intravitreal injection therapy (§4.4).
  • Confirm the saline irrigation step has been completed — the iodine colour should have disappeared from the eye (§4.2, §4.4).

Clinical monograph

How it works

It releases free iodine that oxidises microbial proteins, nucleotides and lipids, producing rapid, broad-spectrum killing of bacteria, viruses and fungi on the ocular surface.

Prescribing in practice

  • It is an antiseptic for surgical/procedural skin and conjunctival preparation, not a treatment drop, and the higher concentrations used for periocular skin must not be introduced into the eye in the same strength.
  • Avoid in patients with known iodine hypersensitivity and use caution with thyroid disorders given systemic iodine absorption with repeated exposure.
  • Adequate contact time on the ocular surface is needed for antisepsis, after which residual solution is irrigated as per local protocol.

Monitoring

No routine monitoring is required for single peri-procedural use; observe for surface irritation or hypersensitivity reactions.

Counselling the patient

  • This is a cleaning antiseptic used to make the eye sterile before your procedure, not a medicine to take home.
  • Tell the team if you have ever reacted to iodine or iodine-containing antiseptics.
  • Some transient stinging or surface dryness afterwards is expected and settles.

Evidence & guidelines

Pre-operative povidone-iodine antisepsis is the established standard for reducing endophthalmitis risk before intraocular surgery and intravitreal injection, endorsed by ophthalmology surgical guidance.

Reference: RCOphth Intravitreal Injection Guidelines 2023; NICE TA155; SPC Betadine Ophthalmic; Tabatabaei et al. Cornea 2019 (EKC); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways