The three broad types of eye surgery are refractive surgery (to correct vision), cataract surgery (to replace a clouded lens), and glaucoma surgery (to lower eye pressure). These categories cover the vast majority of procedures performed by eye surgeons, though retinal surgery is another important category for conditions like retinal detachment. Each type works differently, targets a different part of the eye, and comes with its own recovery timeline.
Refractive Surgery: Correcting Your Vision
Refractive surgery reshapes the cornea, the clear front surface of your eye, so that light focuses correctly on the retina. It treats nearsightedness, farsightedness, and astigmatism. The goal is to reduce or eliminate your need for glasses or contacts. The three main procedures are LASIK, PRK, and SMILE.
LASIK is the most popular option. Your surgeon creates a thin flap in the corneal tissue, folds it back, then uses a laser to reshape the cornea underneath. The flap is laid back down and heals on its own. Recovery is fast: most people return to work and driving within 24 hours. LASIK works well for nearsightedness, farsightedness, and astigmatism, but it requires enough corneal thickness to safely create that flap.
PRK was developed before LASIK and skips the flap entirely. Instead, the outer layer of the cornea is removed, and a laser reshapes the surface directly. Because there’s no flap, PRK is a better fit if you have thin corneas, a high prescription, or a lifestyle that puts your eyes at risk of impact (boxing, martial arts, military service). The tradeoff is healing time. Vision stays blurry for up to three weeks, and doctors often recommend doing one eye at a time. You’ll wear a protective contact lens for five to six days after the procedure while the outer layer regrows.
SMILE is the newest of the three. Instead of creating a flap or removing the surface layer, a laser cuts a small disc of tissue inside the cornea, and the surgeon removes it through a tiny incision. No flap, no surface removal. Recovery takes about a week, putting it between LASIK and PRK. SMILE currently corrects nearsightedness and astigmatism but is not used for farsightedness.
All three procedures are considered elective, so most insurance plans don’t cover them. LASIK costs around $2,000 per eye on average, and PRK and SMILE fall in a similar range depending on the provider.
Cataract Surgery: Replacing a Clouded Lens
Cataract surgery removes the eye’s natural lens after it becomes cloudy with age and replaces it with a clear artificial lens. It is the second most commonly performed eye procedure in the United States, behind only injections for retinal conditions. Unlike refractive surgery, cataract removal is medically necessary and typically covered by insurance and Medicare.
The standard technique, called phacoemulsification, uses ultrasound energy to break the cloudy lens into small pieces. Your surgeon makes a small incision in the cornea by hand, inserts a pen-shaped probe behind the pupil, and uses sound waves to fragment the lens. The pieces are suctioned out, and an artificial lens is placed in the same capsule that held your natural lens. The incision is self-sealing and usually needs no stitches.
Laser-assisted cataract surgery follows the same basic steps but uses a laser to make the initial incisions and soften the lens before the ultrasound probe finishes the job. A camera maps your eye’s surface beforehand, programming the laser for precise depth and placement. This can also correct astigmatism during the same procedure by making specific reshaping incisions in the cornea. The laser reduces the amount of ultrasound energy needed, but studies from the American Academy of Ophthalmology have not found that laser-assisted surgery produces fewer complications or better outcomes than the traditional technique. Surgeon skill and experience matter more than which method is used.
Most recovery happens between 8 and 20 weeks after surgery. About 12% of patients experience postoperative complications, the most common being inflammation and temporarily increased eye pressure. Serious complications like infection or retinal detachment are uncommon. The surgery itself takes only about 15 to 20 minutes per eye and is typically done under topical anesthesia, meaning numbing drops on the eye rather than general anesthesia. You stay awake but feel no pain.
Glaucoma Surgery: Lowering Eye Pressure
Glaucoma damages the optic nerve, usually because pressure inside the eye is too high. When eye drops and other medications can’t control that pressure well enough, surgery creates a new drainage pathway for the fluid inside the eye. There are two main approaches: traditional surgery and a newer category of less invasive procedures.
Trabeculectomy has been the standard glaucoma surgery for over 50 years. The surgeon creates a small opening that allows fluid to drain from inside the eye into a space beneath the outer membrane. This can bring eye pressure down to very low levels, making it the best option for advanced glaucoma or when extremely low pressure targets are needed. It’s often described as a “fit and forget” solution because it can provide lasting pressure control without ongoing adjustment. The tradeoff is a longer recovery and a higher risk of complications compared to newer options.
Minimally invasive glaucoma surgery, or MIGS, refers to a group of procedures that use tiny devices or instruments inserted through the front of the eye, avoiding the need for an external incision. Some work by opening or bypassing the eye’s natural drainage channel. Others place microscopic stents to create new outflow routes. Because these procedures are less disruptive, they carry fewer risks and recover faster, but they generally don’t lower pressure as dramatically as trabeculectomy. MIGS procedures are designed to fill the gap between eye drops and major surgery, and they work especially well when combined with cataract surgery in patients who have both conditions.
Like cataract surgery, glaucoma procedures are medically necessary and covered by insurance. Most use topical or regional anesthesia. With regional anesthesia, a numbing injection near the eye keeps it still and pain-free during the procedure, while you remain awake.
Retinal Surgery: Repairing the Back of the Eye
Though not always included in the “big three,” retinal surgery is a major category worth knowing about. It treats conditions like retinal detachment, where the light-sensitive tissue at the back of the eye pulls away from its supporting layer. Left untreated, this causes permanent vision loss.
The three main approaches to retinal detachment repair are pneumatic retinopexy (injecting a gas bubble to push the retina back into place), scleral buckling (placing a band around the outside of the eye to push the wall inward toward the detached retina), and vitrectomy (removing the gel inside the eye to access and repair the retina directly). Which one your surgeon recommends depends on where the tear is located, how severe the detachment is, and your age. Scleral buckling works best in younger patients with detachments caused by tears near the front of the eye, while vitrectomy is preferred for more complex cases or when bleeding or scar tissue blocks the view.
Retinal procedures are medically necessary and insurance-covered. Recovery can involve specific head positioning for days or weeks, particularly after gas bubble procedures, and vision improvement is gradual. These surgeries are less common than cataract or refractive procedures but are critical emergencies when they’re needed.
How Anesthesia Differs Across Procedures
Most eye surgeries don’t require general anesthesia. Cataract surgery, glaucoma procedures, and refractive surgery all typically use topical anesthesia: numbing drops applied directly to the cornea. You stay awake, feel no pain, and go home the same day. For procedures that need the eye to stay completely still, a regional nerve block (a numbing injection around the eye) provides both pain relief and immobility. General anesthesia is reserved for children, patients who can’t stay still or follow instructions, and certain complex retinal surgeries. Your surgeon will assess factors like anxiety, ability to lie flat, and any medications you take (particularly blood thinners) when choosing the anesthesia approach.