Anesthesia for Eye Surgery

Topical is the safest for most eye surgeries.  Cataract surgery, LASIK, and DMEK corneal transplant surgery are often performed under topical anesthesia.  Our surgeons typically use numbing eye drops such as lidocaine. This results in excellent pain control for the patient, especially in procedures lasting less than 20-30 minutes.

After the surgery has begun, it is common to augment topical anesthetic drops with a small infusion of preservative-free lidocaine inside the eye. This helps to prevent pain from any manipulation of the iris or ciliary body during surgery.

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. There is no increased risk of heart attack, stroke, or death from numbing eye drops with monitored anesthesia care. These intravenous medications may cause amnesia for the period of time around the surgery.

Patients recover very quickly from topical anesthesia and can usually return home within 30-60 minutes after surgery.  No eye patch is required if topical anesthesia is used, but patients may be given a clear protective eye shield.

Local anesthesia is used for eye surgeries when an additional level of anesthesia is required.

If a surgery is complex or expected to last 30-60 minutes or more, numbing medicine may be injected around the eye. This is referred to as a “retrobulbar block” and is often used during full-thickness corneal transplants or vitrectomy surgery. The injection is given in the preoperative area under deep sedation and is closely monitored by an experienced nurse anesthetist.

The deep sedation causes the 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 typically placed and left in place until the morning.

Until the block completely wears off, local anesthesia causes complete numbness of the eye, the inability to move the eye, and decreased vision. The numbing effects of the medication may last for several hours.

The risks of local anesthesia include a slight chance of damage to the eye or surrounding structures 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 eye surgery is rare. We make every attempt to perform surgery using topical or local anesthesia, and have been successful in avoiding general anesthesia in many cases where other surgeons might have chosen to use it.

To provide the safest possible experience, our surgeons have become experts in using topical or local anesthesia for patients in difficult situations, with complex ocular problems, movement disorders, autism, dementia, and developmental conditions that would otherwise require general anesthesia.

The only cases in which we feel general anesthesia is indicated are severe trauma or for patients who cannot cooperate, such as young children or those with significant behavioral issues.

General anesthesia “sleep” is quite different from regular sleep because the potent medications affect every organ of the body. Achieving and maintaining the desired effect requires continuous monitoring and adjustment to ensure optimal results. Due to the risks associated with general anesthesia, we perform these surgeries exclusively at the hospital.