Mr. Mohan got his cataract surgery done 45 days back. He was an incredibly happy patient and his vision improvement had been tremendous. In his own words- he got the child-like vision back. With his new normal vision, he could re-start driving and reading. However, after 30 days, he started to experience occasional eye irritation. He would experience it more often while using mobile or laptop for more than 30 minutes. He visited me at the eye hospital, and I noticed that his tear film stability was poor and his oil glands in the lid were blocked. I recommended the dry eyes treatment and that improved his symptoms significantly. Sometimes during post-operative follow up visits of cataract patients, we come across patients who are happy that there is a tremendous improvement in vision after the surgery but equally anxious about mild discomfort / irritation in their eyes. So, is this irritation after cataract surgery normal OR something is wrong with their eyes?
Reasons behind irritation/discomfort after surgery
- Corneal nerves get cut
- Pre-existing Dry eyes
- Use of medicines after cataract surgery
- Other pre-existing eye diseases
- Personality
- Cataract surgery is the most often performed surgery on human body. It has superb success rate, and it gives gratifying results for patients and doctors alike. Some patients may complain of slight discomfort after cataract surgery. It may range from mild to moderate discomfort depending upon patient’s sensitivity and type of procedure used for cataract removal. Cataract surgery has evolved into a minimally invasive refractive procedure. Incision over cornea (the front transparent part of the eye) is an important step in cataract surgery to get entry inside the eye and get access to the lens to be replaced. This incision cuts multiple connections between neurons/nerves over that part of cornea. Patient might feel discomfort because of such incisions. Healing over this region per se can produce abnormal sensation. Though superficial healing occurs within 5 to 7 days, ultimate healing response continues for 3 months on cellular level. This can also affect tear secretion. If patient is already suffering from dry eyes syndrome, surgery can cause extra discomfort to such patients.
- There is minimal inflammation inside the eyes after cataract surgery/ any intra-ocular surgery, this inflammation itself can be a source of discomfort to the eyes. With modern day cataract surgery, incidence of inflammation is very minimal but preexisting inflammatory condition like anterior uveitis, glaucoma, dry eyes can cause additional inflammation leading to more discomfort.
- There are a few eye drops that need to be instilled after the cataract surgery. Patients suffering from diseases like glaucoma etc. would have to put even more eye drops after the cataract surgery. This can cause some discomfort due to preservatives present in the eye drops. Preservative free drops are preferred in such scenarios and drops should be put as per doctor’s advice and not as per one’s convenience.
- Patients with certain condition like Diabetes, Recurrent corneal erosion syndrome, Fuch’s dystrophy, LSCD can develop more irritation in eyes after cataract surgery due to weak structure of cornea, abnormal innervation of cornea and altered healing response.
- One of the most important factors is the patient’s mind set, personality & sensitivity towards pain. It is well known fact that some patients are more sensitive towards pain, and they experience more discomfort even in normal situations. Anxious, type A personality patients complain more about dryness after cataract surgery.
To prevent irritation after cataract surgery, certain medications are advised for particular time frame. These drops keep eyes moist and minimize redness/ inflammation. Lubricant drops after cataract surgery should be continued at least for 3-6 months and even after that if required. Preexisting conditions like uveitis are treated first and then cataract surgery is advised to prevent post-operative inflammation. Cataract surgery is done to improve the vision, mild discomfort should be expected after the surgery and such discomfort will get reduced within few weeks to months after the surgery. Those with pre-existing dry eyes should continue using the lubricating eye drops to minimize such occurrences.
