Eye Pressure Spikes After Injections: Understanding Ghost Cell Glaucoma in Diabetic Retinopathy
A person with severe diabetic eye disease receives an anti-VEGF injection to slow vision loss. Within hours, their eye pressure climbs dangerously high. The culprit: ghost cells—worn-out red blood cells from old bleeding inside the eye that have suddenly shifted forward and clogged the eye’s drainage system. This complication, called ghost cell glaucoma, can develop rapidly and cause permanent damage if not recognized quickly.
What Are Ghost Cells and How Do They Form?
When blood leaks into the vitreous—the clear gel that fills the back of the eye—it gradually breaks down over days. Red blood cells lose their hemoglobin and become rigid, transforming into what doctors call ghost cells. These aged cells measure between 4 and 7 micrometers across and lose the flexibility that healthy red blood cells normally have.
Healthy red blood cells can squeeze through the eye’s drainage meshwork, a delicate tissue that keeps fluid pressure in balance. Ghost cells cannot compress enough to pass through. Instead, they accumulate and clog the drainage system, causing fluid to back up and pressure to rise.
The Candy-Stripe Sign: A Visual Warning
Sometimes the front of the eye displays a distinctive striped pattern that gives ghost cell glaucoma its nickname. A pale, khaki-colored band of ghost cells sits above a heavier layer of fresh red blood, creating what looks like candy stripes.
This visual appeared in a clinical image published in JAMA Ophthalmology in 2026, titled “Candy-Stripe Sign in Ghost Cell Glaucoma.” The lighter khaki layer floats above because ghost cells are less dense than fresh red blood cells. While striking when visible, the candy-stripe pattern is just one way ghost cell glaucoma can present.
When Do Ghost Cells Move Forward?
Ghost cells normally remain trapped behind a thin membrane called the anterior hyaloid, which sits at the front of the vitreous. Surgery and eye trauma are the best-known triggers for breaching this barrier and releasing ghost cells into the front chamber of the eye.
A less familiar—but clinically important—trigger is an anti-VEGF injection, a standard treatment for advanced diabetic eye disease. These drugs, like ranibizumab, help slow the growth of abnormal blood vessels and bleeding. Yet in certain high-risk patients, the injection itself can push accumulated ghost cells forward.
The Beijing Study: Ghost Cell Glaucoma After Anti-VEGF Injection
Researchers at Beijing Tongren Eye Center studied 71 eyes in 68 patients with proliferative diabetic retinopathy—a severe form of diabetic eye disease involving bleeding inside the eye. Each eye received an anti-VEGF injection of ranibizumab before scheduled vitrectomy surgery (a procedure to remove the blood-filled gel).
The results, published in BMC Ophthalmology in 2020, revealed an important risk: 8 of those 71 eyes, roughly 11 percent, developed ghost cell glaucoma within two days of the injection.
Timing varied. Two patients had dangerous pressure spikes within 30 minutes of receiving the shot. Four more developed the condition between 30 minutes and 24 hours later. Two additional patients developed it between 24 and 48 hours after the injection. The average peak pressure reached 46.5 mmHg—more than double the normal range of 10 to 20 mmHg.
Five patients were initially treated with pressure-lowering eye drops. Three of those five also needed a minor surgical procedure to release excess fluid from the front of the eye. All reached normal pressure after undergoing vitrectomy, and none required long-term pressure-lowering medications afterward.
Why the Injection May Trigger This Complication
The Beijing researchers proposed a mechanism: in eyes with large amounts of pre-existing ghost cells and active bleeding, the injection may create a chain of events. The drug causes brief pressure changes inside the eye. This disturbance of fluid within the vitreous, combined with the pressure fluctuation, may damage the anterior hyaloid membrane and push ghost cells forward into the front chamber.
The authors noted that the transient pressure increase from the injection itself “may damage the anterior hyaloid surface of the vitreous body.” This damage allows the barrier to fail, releasing accumulated ghost cells into a space where they immediately clog the drainage system and raise pressure dramatically.
Important Limits of This Finding
The Beijing study enrolled only 71 eyes and focused specifically on patients with proliferative diabetic retinopathy who had existing bleeding. This narrow population does not represent typical patients receiving anti-VEGF injections for milder forms of diabetic eye disease.
Anti-VEGF drugs remain a cornerstone treatment for diabetic eye disease. A major U.S. clinical trial published in JAMA found that ranibizumab was a reasonable alternative to laser treatment for proliferative diabetic retinopathy, at least through the two-year follow-up period. The Beijing team’s advice was targeted: ophthalmologists should monitor eye pressure carefully in patients with severe diabetic retinopathy and existing bleeding who receive an anti-VEGF injection before vitrectomy.
The JAMA Ophthalmology candy-stripe image did not tie its patient’s case to an injection. The image serves primarily as a diagnostic clue that old blood has leaked from the back of the eye into the front, regardless of cause.
How Ghost Cell Glaucoma Is Diagnosed and Treated
Ghost cell glaucoma was first described in 1976 by Campbell and colleagues. It was once mistakenly called “hemophthalmitis,” even though true inflammation is often absent. A red, painful eye full of blood cells can look like uveitis, an inflammatory eye disease, but several clues point toward ghost cells instead.
Doctors look for a quiet conjunctiva (the outer surface of the eye should not be inflamed) and an absence of keratic precipitates—inflammatory deposits on the back of the cornea that appear in true uveitis. Confirming the diagnosis often requires examining a tiny sample of fluid from the front chamber under a special microscope using phase-contrast magnification.
Treatment starts with medications that lower eye pressure, typically topical drops. If pressure remains elevated, surgeons may wash out the ghost cells from the front chamber, remove the blood-filled vitreous through vitrectomy, or create a new drainage pathway. The condition is usually transient, though complete resolution can take many months. The danger lies in how quickly untreated pressure can damage the optic nerve.
When to Seek Immediate Eye Care
Anyone with a history of diabetic eye disease, a recent eye bleed, recent eye surgery, or a recent eye injection should seek prompt evaluation if they experience sudden eye pain, redness, or blurred vision. These symptoms can signal many different problems, and only a comprehensive eye exam can identify the cause.
If you have received an anti-VEGF injection and notice these warning signs within days of the procedure, contact your eye specialist immediately. Early recognition of ghost cell glaucoma makes treatment more straightforward and reduces the risk of permanent vision loss.
The Bottom Line
Ghost cell glaucoma is a rare but serious complication that can emerge rapidly after eye injections in select high-risk patients. While the Beijing study documented this risk in about 1 in 9 eyes with severe diabetic retinopathy and bleeding, anti-VEGF injections remain an important and effective treatment. The key is awareness and careful monitoring by your eye care team, especially if you have advanced diabetic eye disease scheduled for treatment before vitrectomy surgery.
