Cataract surgery involves removing the eye’s cloudy natural lens and replacing it with an artificial intraocular lens. Because many people feel anxiety about eye surgery, they often worry about the level of consciousness maintained during the operation. Patients are not put under general anesthesia. Instead, the standard approach ensures patients are awake, comfortable, and deeply relaxed, allowing them to remain responsive while the surgical team completes the brief procedure.
The Standard Approach to Anesthesia
The foundation of pain management for cataract surgery relies on local anesthesia to numb the eye itself. The most frequently used method is topical anesthesia, which involves applying strong numbing eye drops to the surface of the eye. These drops are significantly more potent than those used for routine eye exams and effectively block pain sensation throughout the surgery.
Some surgeons may supplement the drops with a sub-Tenon’s block, which involves injecting a numbing agent around the eye to provide a deeper level of local numbness. Since topical drops do not paralyze the eye muscles, the patient must focus on a light to help keep the eye still during the operation.
Understanding Minimal Sedation
Beyond numbing the eye, sedation is provided through Monitored Anesthesia Care (MAC), often termed minimal or conscious sedation. This involves administering medication through an intravenous (IV) line, typically managed by an anesthesia professional. The purpose of MAC is anxiolysis—reducing anxiety and promoting deep relaxation, rather than inducing unconsciousness.
Medications often include benzodiazepines (like midazolam) or opioid analgesics (like fentanyl). These drugs make the patient sleepy and comfortable, often resulting in amnesia where the patient forgets parts of the procedure. Although patients may drift off to sleep, they remain responsive to verbal commands and maintain the ability to breathe on their own.
What the Procedure Feels Like
The combination of topical anesthesia and minimal sedation significantly alters the patient’s sensory experience. Because the eye is fully numbed, patients should not feel sharp pain, though they may perceive mild pressure or a sensation of water on the eye. A gritty or scratchy sensation is also common, particularly where the small incision is made.
Visually, patients are unable to see the surgical instruments or details of the operation. Instead, they typically see a bright, swirling light or colors caused by the microscope’s intense illumination. The sedative medications distort the perception of time, which makes the procedure feel much quicker than the actual duration.
Exceptions to Standard Sedation
While the vast majority of adult cataract surgeries use local anesthesia and minimal sedation, some specific situations require a deviation from this standard. A deeper level of anesthesia, resulting in complete unconsciousness, is necessary when a patient is unable to cooperate or remain still for the duration of the surgery.
This includes young children, patients with severe involuntary head or eye movements, or individuals who suffer from extreme claustrophobia or anxiety. Patients with cognitive impairments, such as advanced dementia, who cannot understand or follow instructions, may also require general anesthesia.