Cataract Surgery Complications, Risks and Side Effects

Redness in the eye after cataract surgery is quite common and usually not a cause for concern. This redness can result from minor inflammation or from a small blood vessel breaking (known as a subconjunctival hemorrhage), leading to a bright red spot. These symptoms typically improve within a few days to weeks as the eye heals.

Dry eye is a very common complication after cataract surgery, affecting up to 92% of patients in the first week. The symptoms are usually mild but can last for 1-3 months. Cataract surgery can disrupt the tear film that covers the eye, leading to dry eye.In most cases, dry eye symptoms resolve within 1-3 months without treatment. Artificial tears are the main treatment to add moisture to the eyes.

Some light sensitivity (photophobia) is normal after cataract surgery, but ongoing or severe light sensitivity can be indicative of eye swelling or inflammation. If a patient is experiencing light sensitivity longer than a few days after surgery, they should seek medical care.

Most dizziness experienced after cataract surgery is temporary and should improve as the eye heals and the brain adjusts to the new lens. Patients typically notice a reduction in dizzy spells within a few weeks post-surgery. .

For the first few hours after cataract surgery, you may experience dizziness due to the anesthetic eye drops or because your eye is still in the early stages of recovery. If dizziness persists or remains frequent for days or weeks after the operation, this still may suggest your eye and brain are adjusting to your new vision. You were accustomed to how the cataract refracted light into your eye, so you may need time to adjust to the power of the new artificial lens.

In rare instances, dizziness can indicate damage to part of your eye caused by the surgery or another underlying problem. Report this symptom to your eye doctor or your general practitioner, especially if there are other associated symptoms like nausea.

Floaters are spots in your vision that can drift around in your eyes and cause annoyance. They develop in the vitreous fluid of your eye, and they are also common in people who have had cataract surgery. Typically, floaters are not caused by cataract surgery directly. Instead, the replacement of the cloudy lens with a clear one just makes the floaters more apparent.

When a cataract matures, its size grows and swells in comparison to a normal lens. A clear replacement intraocular lens is much more compact than the cloudy swollen lens. As a result of the smaller thickness, the vitreous gel behind the clear intraocular lens also has a little bit more room to move which can make the vitreous floaters appear more noticeable.

If floaters appear after cataract surgery, talk to your eye doctor. These floaters can be a sign of a retinal tear that will need to be treated. If the exam shows no tears or holes in your retina, the floaters can be left alone. Often, they will decrease or disappear from your sight as they move out of your field of vision or the brain adapts to their presence

Discomfort and pain in and around the eye can feel like a headache. This can usually be managed with over-the-counter analgesic medications and/or anti-inflammatory eyedrops. Headaches after cataract surgery are not common, but it is possible to experience discomfort and eye pain. This often resolves soon after the surgery.

Droopy eyes (called ptosis) are common after surgery and usually disappear within a few weeks, if not sooner. If ptosis persists and affects vision, it may need to be treated with surgery (blepharoplasty).

Mild swelling is normal immediately after surgery, but swelling that is severe or lasts for more than a few days after surgery may need additional treatment, such as anti-inflammatory medications or eyedrops.

Eye surgery, including cataract surgery, can increase pressure in the eye. This can affect vision and eye health, and it can even cause glaucoma. Ocular hypertension is usually treated with medications or eye injections. Ocular hypertension after cataract surgery is relatively common but usually transient, with many patients returning to normal IOP levels within a day. However, close monitoring is crucial, particularly for those at higher risk, to prevent potential complications associated with elevated intraocular pressure, like glaucoma or corneal edema.

IOL dislocation occurs when the IOL that was implanted during cataract surgery becomes dislodged from the “capsular bag” in which it was placed. This can cause a patient to experience blurry vision or double vision. Intraocular lens dislocation after cataract surgery is extremely rare, occurring in less than 3% of patients. It’s usually treated with surgery that replaces the lens or moves it back into place.

In rare cases, cataract surgery may not improve vision. This scenario becomes more likely for patients experiencing multiple eye conditions. Cataract surgery may still be performed in the hopes that vision may be improved despite the presence of another eye disease. Sometimes vision is not expected to improve with cataract surgery, but the eye doctor needs to remove the cataract to see the back of the eye more clearly. Usually, the doctor will discuss with the patient that vision may not improve after cataract surgery if there is another cause for the vision loss.

Examples of eye conditions that can limit vision outcomes after cataract surgery are macular degeneration, retinopathy and glaucoma.

There are also relatively rare instances in which there is a complication during or after the surgery resulting in unexpected vision loss. Patients should be aware that even though most cataract surgeries result in excellent postoperative vision, there is always a minor but real risk of complications resulting in vision loss. It is sometimes difficult to know whether a side effect is severe enough to warrant attention, so it’s important to always discuss side effects with your eye doctor.

Retinal detachment (RD) is a serious but relatively rare complication that can occur after cataract surgery. About 1% of patients will experience retinal detachment. It can occur months, and even years, after cataract surgery. This happens when the sensitive tissue at the back of the eyes (the retina) moves from its normal position. This separates the cells in the retina from the layer of blood vessels that supply oxygen and nutrients to the eye. The longer the retina is detached, the greater the risk of significant, and perhaps permanent, vision loss.

Patients should be vigilant for the following symptoms, which may indicate retinal detachment:

• Sudden onset of floaters: Increased floaters in the field of vision.
• Flashes of light: Perception of light flashes in the peripheral vision.
• Darkening of vision: A shadow or curtain effect over part of the visual field.
• Blurry vision: Sudden blurriness or loss of vision.

If any of these symptoms occur, it is crucial to seek immediate medical attention, as timely intervention can prevent permanent vision loss. In 9 out of 10 times,surgeons can completely restore vision if the detachment is promptly diagnosed and treated.

Mild bleeding immediately after surgery isn’t abnormal and may be a common side effect. However, more serious or ongoing bleeding is indicative of a serious medical emergency. The bleeding may be a result of leaking blood vessels. Immediate care is needed to prevent vision loss.

Endophthalmitis is an infection of the tissues or fluids inside the eye that can (although rarely) occur after cataract surgery. The most common symptoms of endophthalmitis are²:

• Eye pain that keeps getting worse after surgery
• Red eye
• White or yellow pus or discharge from the eye
• Swollen or puffy eyelids
• Decreased, blurred or lost vision

Endophthalmitis is considered a medical emergency. If you have symptoms, see an eye doctor as soon as possible. Endophthalmitis can blind you if it’s not treated quickly.

Laser vision correction procedures do not cause cataracts.⁷ It is possible that if there was a complication during the laser procedure, then this complication may influence the development of a cataract. For example, if there was significant inflammation after LASIK and the patient was on steroid eye drops for a long period of time, long term steroid use may accelerate cataract development.⁸

 Although most cases of postoperative endophthalmitis occur within 6 weeks of surgery, infections seen in high-risk patients or infections caused by slow-growing organisms may occur months or years after the procedure.⁹ Typically, postoperative endophthalmitis is caused by the introduction of microbial organisms into the eye. Once organisms gain access inside the eye, inflammation is likely to occur, making rapid recognition, diagnosis, and treatment critical in optimizing final outcomes.