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Cataract Surgery: What to Expect

Most people who undergo cataract surgery have an uneventful recovery that might involve itching or mild discomfort, with little or no pain. But some people experience moderate to severe eye pain that lasts for weeks. If you’re about to undergo cataract surgery, you need to be aware of this risk, and know what to do if you experience eye pain after the procedure.

Outcomes vary

In a recent study published in the Journal of Cataract & Refractive Surgery, researchers analyzed the results of 21 randomized controlled trials to determine how many people experience inflammation and pain after cataract surgery. All of the people in these studies were adults who had undergone cataract surgery using the phacoemulsification technique.

The number of people who had eye pain varied substantially among the different studies. In most studies, very few or none of the patients experienced any eye pain, not even immediately after surgery. However, in certain studies, 95 percent of people experienced pain right after surgery, 47 percent had pain four days to two weeks after surgery, and 24 percent had pain after two weeks. None of the studies measured pain more than 30 days after surgery.

Although most of those who developed pain had only mild pain, some people experienced moderate or severe pain. In most cases, nonsteroidal anti-inflammatory drugs or corticosteroids relieved the pain. Both types of medication were given as eyedrops, and side effects were minimal.

Because the rate of pain after cataract surgery varied so widely in this analysis—and because these studies had been designed to measure other outcomes, and not specifically to evaluate eye pain—the same researchers conducted a separate study of 196 people who underwent cataract surgery, with results published in Clinical Ophthalmology. All patients completed questionnaires that asked about pain and other eye symptoms before the procedure and then 24 hours, one week, and six weeks after surgery. Ten percent of people had eye pain one day after surgery, and for most of them the pain was moderate. Nine percent had pain one week after surgery, and 7 percent had pain at six weeks.

Possible new treatment

To reduce the risk of pain and other symptoms after cataract surgery, doctors typically prescribe eyedrops that contain an anti-inflammatory medication. However, many people have trouble giving themselves eyedrops, and as a result might not take the medication as often as prescribed.

One option gaining popularity is “dropless” cataract surgery. Instead of having to use eyedrops after surgery, patients receive a single intravitreal injection of a steroid-antibiotic combination during surgery to prevent postoperative inflammation and infection.

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If your doctor offers this option, discuss if the procedure would be appropriate for you. The Food and Drug Administration (FDA) hasn’t approved a combination drug specifically for this purpose, which may be a reason why dropless cataract surgery isn’t more widely available.

Also, researchers have developed a device known as a punctum plug. These tiny plugs, implanted in a small duct next to the eye, are designed to continuously release the correct amount of the corticosteroid dexamethasone over four weeks after cataract surgery, thus eliminating the need for steroid eyedrops. As the punctum releases the medication, it slowly dissolves into liquid, which leaves the body through the tear duct.

Early research indicated the punctum plug may be a reliable alternative to medicated eyedrops. However, the Food and Drug Administration has not yet approved it.

What you should do

Before undergoing cataract surgery, it’s important to tell your doctor if you already have any eye pain. This will allow him or her to compare how much pain you experience before and after the surgery. While it is not uncommon to experience some itching and discomfort soon after cataract surgery, notify your doctor if these symptoms get worse or don’t go away within a few days. Don’t attempt to treat these symptoms with over-the-counter medicine without first discussing it with your doctor.

If your doctor prescribes eyedrops after cataract surgery, make sure you use them exactly as directed. If you have difficulty putting drops in your eyes, ask someone to help you. Don’t stop taking the drops without first talking to your doctor. Let him or her know if the pain persists despite any prescribed treatments.

Learn more about what raises your risk for cataracts.

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