Surgery of any kind can be scary. When you have eye surgery, you usually need to stay awake and conscious so that you maintain control of your eyes.  Our team will do everything in our power to keep you comfortable, especially when it comes to anesthesia. The majority of cataract surgeries done in the US are done with IV sedation and any combination of local anesthesia methods.

Local anesthesia numbs the eye with either an injection around the eye or anesthetic drops placed on the eye. It’s often combined with an injection into the front of the eye itself at the very beginning of the surgery.

Injected vs Topical Anesthesia

The injection of anesthetic around the eye generally produces a deeper anesthesia for the surgery then the topical method but it also comes with an increased risk. There is a very small but potentially serious risk of bleeding behind the eye and a rare chance of hitting the back of the eye with the needle.

Topical anesthesia has lower risk but does not provide quite as deep of an anesthesia. Despite this, most people having cataract surgery with a topical anesthetic do not experience any significant pain during the procedure. 

The other difference between the two anesthesia is with topical anesthesia you maintain your ability to move your eye around whereas with injection anesthesia the eye muscles are temporarily paralyzed so your eye doesn’t move during the surgery.  When you have topical anesthesia it is important for you to try and stare straight ahead at the light in the microscope above you.  Most people accomplish this quite easily.

IV Sedation

Along with the anesthetic to the eye, in most cataract surgeries, an anesthetist will also give you some mild sedative medication through an IV.  This makes you relaxed but does not put you “out”. Some people do fall asleep during the procedure and many report that they don’t even remember parts of the surgery, as the sedative can have mild symptoms of amnesia.

If you come back for surgery on your other eye, it’s common to have significantly less amnesia the second time.  Your body builds up a small tolerance to the medication, so while you’ll still feel relaxed, you don’t get the same full effects. Many people have their second surgery and say it was significantly different than the first time simply because they remembered more the second time.

General Anesthesia

It’s very rare that people need to have general anesthesia to have their cataracts removed.  In today’s world that is mostly done for people who are incapable of cooperating and staying still for the surgery.  For everyone else who can cooperate it is generally not worth the risks to put people to sleep for a surgery that is easily done under a local anesthetic.