Cataract Surgery Anesthesia

There are several types of anesthesia that are used for cataract surgery. These include topical, local, monitored anesthesia care (MAC) with topical and/or local, and general anesthesia. Each of these is described below.

Topical

Topical anesthesia is similar to the type of anesthesia you receive at your doctor’s office when your eye pressure is checked. It refers to the placement of numbing medication on the surface of the eye in order to decrease sensation. The topical medications used for surgery are stronger than those used in the office, and they also have a longer-lasting effect, which makes them appropriate for surgery.

Local

Local anesthesia refers to the injection of numbing medicine with either a needle around the eye, or a cannula inside the eye. This provides a slightly increased numbing effect compared to topical anesthesia alone. Injection inside or around the eye may cause a bit of burning that quickly resolves, but is otherwise well tolerated.

Topical and local anesthesia frequently are used together for maximum effect. In addition, each of these can be repeated as needed for increased comfort.

MAC with Topical and/or Local

Monitored anesthesia care, or MAC, refers to medications that are administered through your IV in order to make you more comfortable during surgery. The types of medications typically used during MAC include pain medication, medications that relieve anxiety, and medications that produce a sleepy state to improve comfort. MAC is typically used in conjunction with topical and/or local anesthesia for cataract removal. This combination is the most common form of anesthesia used today in cataract surgery.

General Anesthesia

General anesthesia is rarely used today for cataract surgery. However, in patients who suffer from dementia, claustrophobia, or mental retardation, or who are unable to remain still for the duration of surgery, general anesthesia may still be used.

One of the reasons why cataract surgery is so safe today, and why it can be performed on elderly patients with such frequency, is the shift toward local and topical anesthesia with MAC. In addition, not only is MAC safer than general anesthesia, it is also easier for patients to recover from after surgery is completed.

Your surgeon may begin your procedure with topical, but then add some local anesthesia during your procedure if you are experiencing discomfort. An important factor during surgery is your ability to remain still. Therefore, if you are uncomfortable, be sure to let your surgeon know. Improving your comfort level will allow you to rest and remain still while your surgeon works. Likewise, you should let your surgeon know in advance if you are claustrophobic, have a panic or anxiety disorder, have difficulty breathing or lying flat, or have back and neck problems. These can all affect your ability to lie flat and remain still for the duration of your surgery. It is helpful for your surgeon to know these things in advance so that appropriate adjustments can be made to maximize your comfort.

Because most eye surgery is done under topical and/or local anesthesia with MAC, the risks of anesthesia in cataract surgery are low. Prior to your surgery, your anesthesiologist will discuss with you the anesthesia that will be used in your case, and its attendant risks.

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