For most eye surgeries we use eye drops such as lidocaine to numb the eye. This results in excellent pain control for the patient, especially in procedures lasting less than 20-30 minutes. Cataract surgery, LASIK, and DMEK corneal transplant surgery are often performed under topical anesthesia. It is common to augment topical anesthetic drops with a small infusion of preservative-free lidocaine inside of the eye after surgery has begun. This helps to prevent pain from any manipulation of the iris or ciliary body during surgery. Furthermore, a highly experienced nurse anesthetist monitors the patient’s vital signs and will administer a small amount of intravenous pain medication or calming medication during the surgery to ensure the maximum level of patient comfort. These intravenous medications often cause amnesia for the period of time around the surgery. Topical anesthesia is the safest technique for most eye surgeries. There is no increased risk of heart attack, stroke, or death from numbing eye drops with monitored anesthesia care. Patients recover very quickly from this type of anesthesia and can usually return home within 30-60 minutes after surgery. No eye patch is required if topical anesthesia is used, but patients are given a clear protective eye shield. This is the preferred method of anesthesia because we feel it is in the safest option and in the best interest of the patient.
For some eye surgeries an additional level of anesthesia is required. If a surgery will be complex or last for 30-60 minutes or more, then an injection of numbing medicine around the eye may be used. This is referred to as a “retrobulbar block”. This type of anesthesia is often used for full thickness corneal transplants or vitrectomy surgery. The numbing medication may last for several hours causing complete numbness of the eye, inability to move the eye, and decreased vision until the block completely wears off. This injection is given in the pre-operative area under deep sedation and close monitoring by an experienced nurse anesthetist. The deep sedation causes a patient to fall asleep for a few moments while the block is administered. The patient continues to breathe on their own during this time, so no breathing tube is required. After the block is administered the patient wakes up and is taken to the operating room. The surgery proceeds with the patient awake, but relaxed, and still carefully monitored. After surgery an eye patch is usually placed and left until the next morning. The risks of retrobulbar anesthesia include a small chance of damage to the eye or structures surrounding the eye from the needle used to administer the anesthetic. There is an extremely remote chance of the anesthetic medication reaching the fluid around the brain, which could lead to loss of consciousness and the need for supportive measures until the anesthetic dissipates.
The use of general anesthesia for ocular surgery is quite rare. This type of anesthesia carries a small but very real chance of heart attack, stroke, or even death. These severe complications are more common in individuals with chronic medical problems, advanced age, or generally poor health. Rarely healthy people will have an unexpected serious reaction to general anesthesia which can lead to significant complications or even death. Even though these serious complications are rare, there is usually no need to accept these risks for ocular surgery. The only cases where general anesthesia is indicated are severe trauma or patients who cannot cooperate such as young children or those with significant behavioral issues. Due to the risks of general anesthesia we perform these surgeries at the hospital only. Surgery at a hospital entails additional risks of hospital acquired infections and instruments and staff that may not be as familiar to the surgeon as in our ambulatory surgery center. For these reasons we make every attempt to perform surgery using topical or retrobulbar anesthesia in our own surgery center. We have been successful in avoiding general anesthesia in many cases where other surgeons might have chosen to use it. We specialize in using topical or retrobulbar anesthesia with conscious sedation for patients with complex ocular problems, movement disorders, autism, dementia, and developmental conditions that would otherwise require general anesthesia to provide the safest possible experience for our patients.
May 25, 2021 at 11:22 am
It really helped when you talked about different types of anesthesia and their characteristics. Recently, my grandmother’s sister mentioned she’s getting eye surgery. She’s not very fond of hospitals and gets very agitated, so I think she’ll need a strong dose, and this article could help her understand more about it. Thanks for the advice on the use of anesthesia during eye surgeries.
December 8, 2022 at 8:58 pm
Thanks so much for talking about anesthesia and when it’s used for eye surgery. I’ve had corrective lenses for as long as I can remember. I’ve been looking into what to expect from LASIK and trying to find a place I can go to get the surgery done.
December 9, 2022 at 8:47 am
Thanks for your comment, Jessie. If you’d like to learn more about what to expect from LASIK, we streamed a live LASIK procedure on a former Miss America. You can see the whole process from start to finish. You can view that procedure here: https://youtu.be/URapNm14nBk
March 4, 2023 at 5:31 pm
I recently had a vitrectomy and was not pleased with the pain management. Despite being given numbing eye drops, I felt the speculum being placed in my eye, and experienced short, but intense pain with the numbing injection. After the injection, I felt no more discomfort. After the surgery the side of my face from just below the affected eye up onto my head was profoundly numb. It took at least 4 hours for the numbness to completely reverse. The nurse seemed familiar with this side-effect, but when I mentioned it to the doctor at the follow-up appointment, his response was, “Huh.” I’ve been trying to research this in order to confirm my experience, but am having trouble finding information about the drug used. Is this something you are familiar with? What steps should I take to improve my overall experience if I have this procedure done in my other eye?