One of the most common questions patients ask before cataract surgery is what the anaesthesia will feel like. The good news is that most cataract surgery at our cataract surgeons at Northern Eye Consultants is performed with your eye completely numb but with you awake, relaxed, and breathing independently throughout. This approach, called topical anaesthesia with intravenous sedation, is the safest option for most patients and allows for a rapid recovery with minimal fasting and no risk of general anaesthetic complications.
The standard approach: topical anaesthesia with sedation
For most patients, cataract surgery at Northern Eye Consultants is performed under a combination of anaesthetic eye drops, a small amount of anaesthetic injected into the eye at the start of the procedure, and a light intravenous sedation given by the anaesthetist.
The eye drops numb the surface of the eye. The small injection of anaesthetic inside the eye, called intracameral anaesthesia, numbs the internal structures of the eye that are sensitive to touch. Together these provide complete pain control throughout the procedure.
The intravenous sedation produces a state of deep relaxation and mild drowsiness. You will be aware of what is happening around you, you will be able to hear and respond to instructions from your surgeon, and you will be breathing on your own throughout the procedure. You will not need a breathing tube. Most patients describe the sedation as making them feel calm and relaxed, and many are surprised by how comfortable the experience is.
You must not drive on the day of surgery due to the sedation. A friend or family member needs to take you home. Most patients are ready to go home within one to two hours of the procedure.
What will I feel during the procedure?
Your eye will be completely numb. The most common sensations are pressure and vibration rather than pain. You will see light from the operating microscope, which can be bright, and you may see shifting colours or light patterns during the procedure. You will not see the surgical instruments.
Most patients find the experience much less uncomfortable than they expected. The part that some patients find slightly uncomfortable is the speculum placed to hold the eyelids open, but this is not painful.
If at any point you feel discomfort during the procedure, tell your surgeon immediately. Additional anaesthesia can be given.
Are there other anaesthesia options?
In some circumstances, an injection of local anaesthetic around the eye (called a peribulbar or sub-Tenon block) is used instead of or in addition to the eye drops. This produces complete numbness and stillness of the eye for several hours. It is used for more complex procedures or for patients where topical anaesthesia alone may not provide adequate coverage.
General anaesthesia, where you are fully asleep, is used only rarely for cataract surgery. It is reserved for patients who cannot cooperate with awake techniques, such as those with severe dementia, significant movement disorders, or extreme anxiety. General anaesthesia carries higher risks for elderly patients and requires a longer recovery period, which is why topical anaesthesia with sedation is preferred wherever it is safely possible.
For a detailed explanation of all three anaesthesia options including their risks, benefits, and how comorbidities affect the choice, see the full guide to cataract surgery anaesthesia at corneaeyedoctor.com.
What if I take blood thinners or other medications?
Tell your surgeon and anaesthetist about all medications you take, including blood thinners such as warfarin, rivaroxaban, or aspirin, and any medications for the prostate such as tamsulosin. Topical anaesthesia does not require modification of blood thinners, which is one of its advantages over injection-based blocks. Your pre-operative instructions will specify whether any medications need to be adjusted before surgery. For information on costs and Medicare information for cataract surgery, see the fees guide on our site.
What if I am anxious about being awake?
Anxiety about being awake during eye surgery is very common and completely understandable. The intravenous sedation is specifically designed to address this. Most patients who are anxious beforehand report being surprised by how relaxed and comfortable they felt during the procedure.
If you have significant anxiety or a specific concern about any aspect of the anaesthesia, raise this at your pre-operative assessment. Your anaesthetist can discuss the sedation level and any additional measures that can be taken to make the experience as comfortable as possible.
How to prepare for your surgery day
Follow the fasting and medication instructions provided to you before surgery. Arrange for a friend or family member to drive you home and stay with you for several hours after the procedure. Wear comfortable clothing and avoid wearing eye makeup on the day. Bring your glasses if you wear them. Leave jewellery at home.
Your surgery will be performed at cataract surgery at Northpark Private Hospital, Bundoora. You will meet your anaesthetist on the day before the procedure begins.