Cataract surgery

Cataract surgery: what will happen

Mr Radford aims to make your surgery and experience of visiting the hospital as stress-free and pleasant as possible. The following information is intended to show you what will happen when you undergo cataract surgery.

Before your surgery – how you can prepare yourself

Please remember to avoid wearing your contact lenses before coming to your biometry appointment. Soft lenses should be left out for one week leading up to your appointment and hard lenses left out for two weeks before.

Your contact lens can change the shape of the front of the eye (cornea) and interfere with the accuracy of measurements. Biometry works out which power replacement lens to use in your eye once the cataract lens has been removed.

The day of surgery – what you need to know

Eat and drink normally if you are having local anaesthesia. You should follow your normal routine and take all tablets and medications as usual. For local anaesthetic cataract surgery, there is no need to stop blood thinning treatment.

If you are having sedation or general anaesthesia, follow the instructions in your admission letter from the hospital. You will be asked to drink clear liquids up to two hours before surgery and to avoid eating for six hours before surgery. General anaesthetic procedures are usually carried out first thing in the morning. If you are on insulin you will be given specific instructions.

Preoperative drops

Patients who have suffered previous eye problems may have been given drops to start several days before the date for surgery. It is important that drops are not opened until this time. Most patients will be given anaesthetic and dilating drops on the ward before coming to theatre. Sometimes dilation is possible in theatre and only anaesthetic and sterilising drops are needed before coming to the operating theatre.

The anaesthetic drops used are excellent and, for 99% of patients, this is all they need, with additional drops given throughout the operation to ensure comfort. If you are more sensitive, then additional anaesthetic is easily and quickly given, and is instantly effective.

After surgery – what to expect

Straight after surgery, patients usually find their vision is blurry due to the light used, which has a lower intensity setting for your comfort. You will go back to the ward and have your post-operative drops and any other medication ready. Additional drops and tablets are occasionally given to keep pressure in the eye controlled. You will receive post operation instructions and information of how to care for your eye, contact numbers for any questions, which are available 24 hours a day, and details of follow-up appointment dates.

After a short while, the vision will recover. You will wear a clear patch so you can’t accidentally touch your eye as it is important not to rub it even if it feels itchy or gritty in the first two weeks. No stitches are usually required so your eye seals itself.

Post operation – day one

On the first night after surgery, your eye may feel gritty or irritable. This is due to the small incision site healing, which will usually happen overnight. For the first one or two days this sensation may still be present to some extent, but should be getting better all the time.

On the morning after the surgery, your eyelids may be stuck together and have some discharge. This is simply your own extra tears and can be cleaned away gently with cooled previously boiled water and a cotton bud or pad.

You may find the light is much brighter and that white objects appear to have a bluish tinge if this is your first eye surgery. If you still have cataract in your other eye, you may notice that everything looks yellowy or ochre-coloured in comparison. This colour change is normal in some patients, depending on the density of the cataract.

Possible symptoms within the first 24 hours

No symptoms at all, everything feels great – most people

Itchy gritty eyes – very common, especially if you have dry eyes already. You can use fresh artificial tear drops for comfort.

Watering – this is due to wound healing and will usually settle quickly.

Sticky eye lid – this could happen during the first few mornings after surgery.

Brightness – the eye is now clear and vision should be bright. Sunglasses may be needed.

Initial blur on waking – this can occur until the tear film and cornea settle.

Common causes of temporary blurring in days one to 14

The following symptoms should clear with further treatment and time:

• Dry eyes
• Poor tear film
• Drop sensitivity
• Allergic reaction to drops (preservative-free drops will be given)
• Inflammation in the eye
• Swelling of the cornea

Later causes of blurring

Persistent inflammation in the eye occurs in less than 4% of cases, which can be treated with steroid drops. The likely cause is failing to use drops or stopping them too soon, especially in the first three weeks after surgery.

Fewer than one in 8000 cases experience slowly or rarely non-resolving corneal swelling, which is more likely if there is a pre-existing corneal condition. This can also occur if you have undergone longer, more complex surgery, which can happen with a much denser cataract. Preventive measures are taken during surgery to limit this symptom, which will have been mentioned before or during surgery. Just two patients in 20 years have needed a corneal graft to try to correct the swelling. Most people have no swelling and those that do are usually better in a week, with the rest improving over a few weeks.

Retinal swelling, known as CMO (cystoid macula oedema), affects up to 2% of people. In 50% of affected patients, this improves spontaneously, without any treatment. Some people are more at risk and preventative treatment can be given to try and reduce CMO occurrence or duration.

All of the above almost always get better and sight is fully clear again

Rare outcomes – when you should seek urgent attention

If, after your first two or three days of good vision, your eyesight starts to become blurred or uncomfortable you must contact us for urgent review. Infection after surgery is rare, but if it is missed or treatment is delayed you might very well lose vision partially or completely in the affected eye.   

Don’t delay if things are getting worse after being good for the first few days. Increasing pain or blurring in the first few days means you need to be seen and treated. Usually this is not serious and can be quickly sorted. However, it may mean infection despite antibiotics. If treated quickly eyesight can be saved.

If your vision has been blurry for the first few days and has been so since the end of surgery, this is usually due to some swelling of the cornea which will almost always improve. As each day passes you will begin to notice that, from the morning to the evening, things will get better. The next morning will be again blurry but vision should clear as the day goes on.

Most patients with some corneal swelling after surgery will be back to clear eyes and vision by 7-10 days. If you have a dense cataract or longer surgery, this is more likely to happen. If you already have a condition affecting the cornea (Fuchs’ dystrophy) then delayed clearing is very likely and can take weeks or months. Most patients experience no swelling or so little that their vision is clear in 24-48 hours.

Raised pressure   

Mr Radford uses techniques to absolutely minimise the risk, but in rare cases eye pressure can be high the first night after surgery. This will typically begin to settle itself over about six hours. Very raised pressure can be rapidly treated to give you comfort again.

If you have concerns then get in touch with us

We are always available to help.

It is rare things happen, we make every effort to get you better again.

Almost always we will get your eye better

If you have any concerns you can contact: