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 don't feel it during the procedure. (Learn More)

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. (Learn More) In some cases, you may need to go under general anesthesia or at least receive a sedative or other medications to help you relax. (Learn More)

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. (Learn More)

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. (Learn More)

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 anesthesia

Nearly 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.

Options for Anesthesia

There are several forms of anesthesia used for cataract surgery. Your doctor and you can decide together what is the best course of action for you.

If you are healthy and comfortable being awake during surgery, topical anesthesia may be ideal. Individuals who are nervous or suffer from medical conditions that make it hard to hold still may benefit best from full sedation.

Common forms of anesthesia for cataract surgery include:

  • Topical anesthesia. Eye drops are placed in the eye to numb it.
  • Needle-based eye block: Medication, often lidocaine, is injected into the eye or surrounding area to numb it completely.
  • Facial nerve block. With this type of anesthesia, the entire face is numbed through a needle-based block. It is generally reserved for only those who may face surgical complications otherwise.
  • General anesthesia. With general anesthesia, you will be completely sedated for the duration of the procedure through IV medications.

Topical anesthesia is gaining popularity, as cataract surgery advances and becomes less invasive, but injectable blocks are still widely used. A combination of techniques can be helpful.

General anesthesia is usually only needed for pediatric patients and those with significant medical or mental conditions that will prevent them from being able to hold still for the short procedure. Often, the topical options and needle blocks are enough.

Medications that can help you relax and stay calm may be given in addition to the anesthesia. These may be administered orally, through injection, or via an IV. Usually, these medications help you to not remember the procedure either. Medication dosage depends on weight, body composition, medical or mental health conditions, and overall physical and mental health.

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.