A cataract occurs when the lens of the eye becomes cloudy and needs to be repaired through surgery. Usually, a replacement lens is implanted.

This is a surgical procedure that requires anesthesia. For cataract surgery, anesthesia is the medication used to numb the eye so you do not feel it during the procedure.

Since cataract surgery is an outpatient procedure, lasting only about an hour or less, you will remain awake and receive local anesthesia in the form of eye drops or a needle-based block most of the time. In some cases, you may need to go under general anesthesia or at least receive a sedative or other medications to help you relax.

To prepare for cataract surgery and anesthesia, you will need to follow your doctor’s instructions. Refrain from eating or drinking after midnight the night before, take any necessary medications as directed, and be sure you have someone to drive you home from the procedure.

Cataract surgery is relatively quick and noninvasive. Anesthesia can make it even more seamless, although there are some potential risks for both surgery and anesthesia.

Cataract surgery is typically considered to be a safe procedure. Talk to your doctor to better understand how it can work for you.

Anesthesia for Cataract Surgery

patient going under anesthesiaNearly 10 million cataract surgeries are performed around the world every year, making it one of the most common surgical procedures.

Cataract surgery can be completed in 15 minutes as an outpatient procedure. One of the most common forms of cataract surgery involves placing an intraocular lens into the eye, often with the assistance of lasers. The incisions are very small, and the procedure is not very invasive.

Anesthesia is the administration of medications to block or numb pain during a surgical procedure. It is usually provided by a special doctor called an anesthesiologist.

Since cataract surgery is fairly quick and noninvasive, the anesthesia is usually light. The eye can be numbed locally, eliminating the need for full sedation most of the time.

The doctor will numb your eye itself and generally keep you awake during the surgery. You will often be given either oral or intravenous (IV) medications to help you relax and remain comfortable.

Common Forms of Anesthesia Used

Eye surgeons have a variety of anesthetic options at their disposal for a cataract procedure. In conjunction with your doctor, you will get to decide which option is right for you.

The most common types of anesthesia used in cataracts and other types of surgery are:

  • Topical anesthesia
  • Needle-based eye block
  • Facial nerve block
  • General anesthesia

If you're in good health and can remain comfortable and relaxed during the procedure, then local anesthesia can be a better option for you. On the other hand, if you struggle with a medical condition that makes you restless or if you have anxiety issues, full sedation is recommended.

Topical Anesthesia

Topical anesthesia is the most popular, followed by injectable blocks. In fact, doctors often use the two simultaneously. It involves the use of eye drops, which doctors administer to creates numbness.

As the doctor operates, you're likely to stay awake. The doctor will give drop a numbing agent in your eye. The doctor may also use lidocaine, an anesthetic agent, to inject the area around or inside the eye. This is often used to minimize or suppress pain post-surgery. Lidocaine and eye drops are often used together.

Needle-Based Eye Block

Needle-based eye block, otherwise known as the retrobulbar block, is another type of local or regional anesthesia. It involves injecting the nerves in intraocular or cataract surgery. In this procedure, the pain-numbing medicine is injected into the retrobulbar area, the space behind the eye globe.

This results in akinesia of the extraocular muscles, which block the three cranial nerves that influence the movement of the globe. Needle-based eye block also works by providing sensory anesthesia of the cornea, uvea and conjunctiva by suppressing the ciliary nerves. Injectable medication such as lidocaine is also used in this technique.

Facial Nerve Block

Also known as a trigeminal nerve block, a facial nerve block works by numbing the entire face through a needle-based block. Doctors only recommend it if there's a possibility you may suffer surgical complications. Doctors also employ a facial nerve block for:

  • Trigeminal neuralgia
  • Herpes zoster infection
  • Other atypical facial disorders

Trigeminal nerves play a vital role in the function and sensation of your face. It is the nerve that enables you to chew, bite or swallow. When the nerves are blocked, you won't feel any physical pain.

In this procedure, the anesthesiologist administers relaxation medications through an IV. The doctor then inserts a laser or thin needle in the side of your face or eye and administer the injection. With the help of X-ray guidance, the doctor gives a second injection for steroid pain.

The procedure lasts 30 to 45 minutes. Then you'll be discharged.

General Anesthesia

General anesthesia is physician-delivered sedation, a medical procedure administered through a mask or an IV placed in the vein. While the anesthesia works, you’ll be unconscious, and many of your body’s functions will slow down or need help to work effectively.

Your doctor may place a tube in your throat to help you breathe. During surgery, the physician/anesthesiologist will monitor your heart rate, blood pressure, breathing and other vital signs. And you remain unconscious, free of pain.

Once the operation is completed, the doctor will reverse the medication and wake you up. Nurses will continue monitoring your circulation, breathing patterns and oxygen levels as well as your vitals.

Some people may feel fine after undergoing anesthesia, while others may experience chills, nausea, or vomiting. However, your doctor will help you manage and cope with these side effects of general anesthesia.

Ideally, general anesthesia for cataract surgery is often used in young children, people with particular mental and emotional needs, and people who suffer from acute anxiety. The sedatives help them to relax during the procedure.

Relaxation Medications for Cataract Surgery

These medications are often administered to help you relax and stay calm during the operation. They are often administered orally or through injection or IV. These medications also help you avoid the memory of the procedure and can be administered depending on body weight and overall health. However, for general anesthesia, the anesthesiologist will need to use the lowest doses of medications for anesthesia and relaxation.

Anesthesia After Surgery

Anesthesia typically wears off after an hour or two, and you can go back home soon afterward.  However, the drugs can stay in your system for up to 48 hours. The procedure is non-invasive, meaning it requires little cutting and stitching. You’ll recover in less than a week.

The benefits of anesthesia include the ability to suppress or avoid pain through numbness and to keep you comfortable and relaxed throughout the procedure (3). However, the less medication your anesthesiologist administers, the better. Your doctor will take you through each option to determine one that works best for you.

Is Anesthesia Necessary for Cataract Surgery?

Doctors sometimes get asked by patients if anesthesia is necessary for cataract surgery. The answer is yes.

The surgery, known as phacoemulsification, involves a tiny cut in your eye. The affected, cloudy lens is expertly removed from the eye, and a new, artificial lens is implanted in its place.

Because of the precision nature of the procedure, it’s imperative that the patient can tolerate needles and lasers operating on the eyes. No anesthesia leaves this up to chance, not something surgeons like to do. The risk of a patient moving, flinching or screaming out during a delicate procedure can only help minimize the effect of the procedure.

The operation involves using an intraocular lens to correct the cloudiness in the eye. It is not an invasive procedure and can be performed with a laser. The doctor will first administer anesthesia to numb your eyes before conducting the procedure.

Doctors perform an estimated 10 million cataract surgeries a year worldwide, making it the most common medical procedure. It usually takes 15 to 60 minutes, and you can go home as soon as it is done.

Generally speaking, ...

Generally speaking, for cataract surgery, the medical team will want to use the least invasive procedure and the lowest dosage of medications and anesthesia possible. You and your doctor can work out a plan together for what is likely to be optimal for you.

Preparing for Anesthesia

When getting ready for cataract surgery, you will need to undergo eye exams and specific tests to determine the optimal procedure and medication regimen for you. Your medical and physical health will play a role.

Be honest with your doctor if you are having concerns or think that holding still or being awake might be an issue for you. Your doctor will help keep you as comfortable as possible.

The day before the procedure you will likely be asked to not eat or drink after midnight or on the day of your surgery. You can usually drink water. You may need to take certain medications as directed by your doctor.

Anesthesia for cataract surgery generally wears off enough to allow you to leave the surgery center after an hour or two, however medications can stay in your system for up to a day or so. You will need to make sure that you have someone on hand to drive you home from your surgery. Since cataract surgery is generally done quickly and does not involve a lot of cutting or stitching, the medications will not need to be very heavy and recovery is often fast.

Anesthesia Risks & Benefits During Cataract Surgery

All surgical procedures carry some risk, but in general, cataract surgery and the anesthesia used are considered safe. The surgery has a high success rate.

Most of the risks related to cataract surgery involve complications from the surgery itself, such as infection, inflammation, retinal detachment, dislocation of the lens, vision loss, or a secondary cataract.

Complications related to anesthesia usually involve reactions to medications, but there can be issues related to injections as well. Injections into the eye can cause perforations or damage to the muscle, and general anesthesia can involve risk of central nervous system depression. Topical anesthesia carries fewer of these potential hazards, but you will need to be able to hold completely still throughout the procedure.

Cataract surgery generally improves vision in most people. It can be performed quickly at a surgical center with few complications and low levels of risk.

Pros of cataract surgery anesthesia include the ability to numb potential pain and keep you comfortable during the procedure. Usually, the less medication the better. Your doctor will work with you to decide on the proper dosage and level of anesthesia that will be right for.

References

Cataract Surgery. (October 2011). CMAJ JAMC.

Are There Different Types of Cataract Surgery? (August 2017). All About Vision.

Are You Awake During Cataract Surgery? (August 2017). All About Vision.

Aesthesia for Cataract Surgery. (2019). American Academy of Ophthalmology (AAO).

Anesthesia for Cataract Surgery: Recent Trends. (December 2010). Oman Journal of Ophthalmology.

Cataract Surgery. (March 2018). Mayo Clinic.

Types of Anesthesia. American Society of Anesthesiologists.

Anesthesia for cataract surgery: Recent trends. (December 2010). Oma Journal of Ophthalmology.

Anesthesia Management During Cataract Surgery: Summary. (July 2000) NCBI.

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