Is Cataract Surgery Painful?

If you’ve been diagnosed with a cataract in your eye, you’re probably wondering what’s involved in the surgery and recovery. Human nature being what it is, the thing that concerns most people (apart from risk of complications) is ‘will it hurt?’ This post addresses this frequently asked question.

Does the procedure itself hurt?

One of the big differences when your eye has cataract surgery (compared to laser eye surgery) is that you are sedated. This is not a general anaesthetic, and you do remain awake during the procedure, but a gentle sedation given through a vein in your arm. Apart from the prick of a tiny needle, which most people don’t feel, there is no discomfort associated with sedation, which puts you into a ‘twilight’ state. While you can still respond to basic instructions from the surgeon, such as ‘look at the light,’ you will often have little memory of the procedure afterwards. One minute you’re talking to the anaesthetist, the next you are being offered tea and refreshments after your procedure is complete.

Are My Eyes Completely Numbed?

Yes. The eyes are numbed with topical local anaesthetic eye drops. These drops are applied well in advance of surgery and topped up regularly, so there is no pain sensation.

What about afterwards?

Your eyes undergo quite a lot during any procedure, even a micro-surgical procedure like cataract surgery:

  • the eyelids are held apart with a speculum
  • the area around the eyes is disinfected to protect against infection from the normal bacteria present on your skin
  • a cocktail of eye drops is added, some of which can upset the tear-film’s delicate balance

All of this, as well as the manipulation of the eye during the procedure, can lead to inflammation afterwards. This is very well managed with anti-inflammatory eye drops.

 

There are two kinds of anti-inflammatory eye drops used; one is a corticosteroid (usually Maxidex or Pred Forte) and one is a non-steroidal anti-inflammatory – or NSAID – eye drop. These drops dampen down (or switch off) the body’s natural inflammation reaction to the surgery. If they are not used as directed, this can lead to inflammation in the eye, which includes symptoms of pain, redness and light-sensitivity (glare). These drops are usually used for a couple of weeks after your procedure and slowly tapered off, by which time your eyes feel comfortable. Very specific instructions about these drops are given to you after your procedure. You also use an antibiotic drop to protect the eye from getting an infection during the healing period. 

 

What if I’m Getting Pain In My Eye Days Later?

The modern cataract micro-surgery technique is one of the safest procedures you can have and is performed on average once every 30 minutes in Australia. Complications are rare but they can happen and your risk of having one depends on a number of factors that will be discussed with you at your initial consultation with the surgeon. The most common reason for pain after surgery is inflammation. 

Using your steroid and NSAID drops exactly as directed is essential to a smooth recovery. If you are using them as directed and your eye is still painful, or becomes painful a few days after surgery, it is essential to return to your surgeon for review to find out what’s causing the pain. Infections after cataract surgery are very rare but they are possible and can be very serious. Using your antibiotic drops helps protect the eye from infection. As surgeons, we have a very low threshold for seeing a patient again after cataract surgery if they are experiencing pain, redness or blurry vision, especially if this has developed after a few days. If you’re ever in doubt, return to the clinic.