Do’s and Don’ts After Cataract Surgery

Cataract operations are the most common eye surgeries performed in Mumbai and worldwide. After finishing the surgery, an essential thing for cataract specialists is to explain to the patient and their families the eye care after cataract surgery.

What causes cataracts?

A cataract is not a disease. Instead, it is an age-related change in the eye’s lens. The natural lens of the eye is a transparent spindle-shaped structure. Over time, due to age, this transparent lens becomes opaque. As the lens becomes more and more opaque, the patient’s vision deteriorates.

A cataract, whatever type it may be, needs cataract surgery. However, based on the appearance of the cataract, there are various types of cataracts. Some of them are:

1. Oil drop cataract
2. Rosette cataract
3. Sunflower cataract
4. Snowflake cataract

Why are these precautions after cataract surgery so important?

The biggest fear your cataract specialist has after performing cataract surgery is an eye infection. This infection is the most dreaded complication of cataract surgery. The eye is a small organ with very delicate tissues. The retina, which is like the film of the camera (olden day camera) once damaged, is not repairable. Eye infections are treatable, but there can always be some residual defect, and there is always a high risk of losing vision completely. Sometimes if the infection spreads, one may also have to remove the eyeball. This infection is known as Endophthalmitis.

Eye care after cataract surgery is split into a few categories.

1. Eye drops
2. Maintaining hygiene
3. Physical protection to the eye 

What are the eye drops to be used after cataract surgery?

Instilling eye drops are the single most important thing after your cataract surgery. There are mainly three types of eye drops we give to our patients. These eye drops must be put in the eye, taking due care that the tip of the bottle does not touch anything. The bottles should be brand new and never use old bottles.

1. Steroids
2. Nonsteroidal anti-inflammatory drugs
3. Antibiotics
4. Glaucoma eye drops

Steroids

Like any other surgery in the body, Cataract surgery is nothing but a controlled injury to the body. Eye surgeons make wounds and inject stuff into the eye. The body will react after any surgery with inflammation. For example, if you keep hitting your forearm for 15 minutes, you will notice slight swelling or redness. This reaction is inflammation—the body’s reaction to injury. Steroids are anti-inflammatory drugs and help in reducing inflammation. If one does not use steroids, the inflammation can be very severe and harm the eye. Usually, these we give for four weeks in tapering doses.

Non-Steroidal Anti Inflammatory Drugs

These drugs are also anti-inflammatory drugs but are not steroids. You see, steroids have certain disadvantages. We cannot use them for very long, and sometimes they increase eye pressure. Now, people with diabetes can get retinal edema post-cataract surgery, and these patients may need anti-inflammatory drugs for extended periods. NSAIDs are beneficial in this type of situation. We routinely prescribe these drugs for one month.

Antibiotics

Earlier, we mentioned that eye infections after cataract surgery is the worst nightmare. To prevent these infections, we prescribe antibiotic eye drops for two weeks.

Glaucoma Eye Drops

Glaucoma is a condition in which eye pressure increases. Sometimes after cataract surgery, the pressure inside the eye can increase. The following are the reasons for this pressure increase.

1. Inflammation – After surgery, some amount of inflammation is normal. However, the pressure can increase if the inflammation is significant, which can happen in hard cataracts.
2. Residual viscoelastic in the eye – Viscoelastic is a jelly that is used during cataract surgery. This viscoelastic is removed from the eye before finishing the cataract surgery. If there is some residual viscoelastic substance in the eye, it can cause glaucoma.
3. The steroid eye drops used after cataract surgery can also lead to glaucoma.

If the pressure increases, your doctor will prescribe glaucoma eye drops or tablets to lower the eye pressure. The rise in pressure is temporary, and usually, the eye drops stop after a week.

Maintaining Hygiene after Cataract Surgery?

Hygiene is the most important thing to keep in mind after cataract surgery.

1. No head bath for ten days means one cannot let water enter the eye. One cannot wash the face but only wipe the face with a napkin.
2. No touching, itching, or rubbing of the eyes.
3. After pouring the eye drops, it is essential to remove the excess medicine which may settle on the eyelashes or the corners of the eye. This we can do with sterile cotton.
4. We advise patients not to venture out of home for that and the next day to avoid dust and particulate matter entering the eye. If someone works in an office environment, they can resume working the next day, taking due precautions.

Physical protection to the eye after your cataract surgery 

After the cataract surgery, we give our patients protective glasses. You can see how these glasses look in the video below. These glasses tend to cover the eyes and the temples and prevent dust from entering the eyes.

We also request patients wear a protective cup on their eyes when they sleep. We also provide skin tape to stick this cup onto their face. This cup prevents patients from inadvertently poking their eyes while they are sleeping. Use this cup for at least the first 2-3 days after the surgery.

Exercising for the first week after your Phaco Surgery?

Cataract specialists don’t want you to perform those exercises that increase eye pressure. Performing intense breathing exercises while doing yoga is one example. Even trying to maintain challenging postures during yoga is not at all advised. Doing a headstand is a big no-no. Dr Deepak did a study with his colleagues at Sankara Nethralaya in which they measured the eye pressure in patients who did the headstand, also known as Shirshasana. There is a rise in eye pressure. We do not want this in the first week after eye cataract surgery.

“Why do I have blurred vision after my cataract surgery?”

When we perform cataract surgery, we expect patients to start seeing well by the same evening. Sometimes they start seeing well the next day. However, certain conditions may cause blurry or hazy vision after cataract surgery.

1. The harder the cataract, the more post-surgery inflammation and this inflammation can cause blurry vision. Sometimes this inflammation can take a few days to clear. A Few times, this inflammation can take up to 3-4 weeks to clear completely.
2. Retinal oedema post-cataract surgery is another cause of blurry vision. The inflammation after cataract surgery can sometimes cause the retina to develop swelling. This swelling, also known as retinal oedema or Cystoid Macular oedema, causes the vision to become hazy. NSAIDs play an important role in reducing this swelling.
3. Eye infections – these are the most dreaded complications of cataract surgery. We instruct our patients that they must inform us if there is any pain, redness, or blurry vision after cataract surgery. If required, we see these patients the same day to rule out an infection. These days the infection rates after cataract surgery are significantly reduced.

Things not to do after cataract surgery 

Here is the complete list.

1. No bending down
2. No straining 
3. No lifting heavy weights
4. No touching the eyes
5. No scratching the eyes
6. No water can go into the eyes for 8 days after surgery
7. No heavy exercise – walking is fine
8. No Head bath for 8 days after surgery

Things you can do after cataract surgery 

• Watch television
• Use the mobile phone
• Use the computer / Eyepad
• No diet restrictions – You can eat food items which may be hard to bite
• Meet people and talk to them
• Turn your head sideways. It’s not like you have to maintain a stiff neck and be very careful when you turn your head to look sideways
• You can have a drink – a drink or two is fine