LASIK, or Laser-Assisted In Situ Keratomileusis, is an elective refractive surgery designed to correct common vision problems like nearsightedness, farsightedness, and astigmatism. For many considering this quick procedure, the question of being “put under” with general anesthesia is a primary concern. General anesthesia is not the standard protocol for LASIK surgery, nor is it typically offered. The procedure is performed while the patient is awake and entirely comfortable. This approach is fundamental to the success and safety of modern laser vision correction.
The Standard Anesthesia Protocol
Patient comfort during LASIK relies on a highly effective form of local anesthesia. Pain management is achieved exclusively through topical anesthetic drops, which are administered directly to the cornea just before the procedure begins. These drops contain a numbing agent, such as proparacaine, which completely desensitizes the corneal surface within minutes. Since the cornea is the only part of the eye actively treated by the laser, this localized numbing is highly effective for pain control.
Patients do not feel sharp pain during the roughly ten-minute surgery because the nerve endings in the outer layer of the eye are temporarily blocked. Instead of pain, many patients report a sensation of pressure on the eye, particularly when the suction ring is applied during the initial stages of creating the corneal flap. They may also feel a mild foreign body sensation or a cool temperature as the laser reshapes the tissue underneath the flap. To prevent involuntary movements, a small instrument called a lid speculum is used to gently hold the eyelids open.
Managing Patient Anxiety During Surgery
Although topical drops manage physical pain, being awake during eye surgery can cause understandable anxiety for some patients. To address this psychological discomfort, most surgeons offer a mild oral sedative before the procedure begins. This medication is often a low-dose benzodiazepine, such as diazepam (Valium). The goal of this pre-operative dose is to help the patient relax and remain calm throughout the experience, not to induce sleep.
This light sedation helps reduce nervousness, allowing the patient to lie still and follow instructions easily. The medication decreases anxiety and promotes a state of tranquility without causing unconsciousness. This oral sedative does not block pain; its function is to manage the patient’s emotional state. It complements the pain-blocking action of the anesthetic eye drops.
Why Full Sedation Is Not Used For LASIK
The primary reason general anesthesia is not used for LASIK is the necessity of patient cooperation for the procedure’s accuracy. Successful laser vision correction requires the patient to fixate their gaze on a specific target light for the duration of the laser treatment, which typically lasts less than 60 seconds per eye. The surgeon also needs the patient to be able to follow simple verbal instructions immediately. Full unconsciousness makes this level of focus and responsiveness impossible.
Modern excimer lasers utilize sophisticated eye-tracking technology to ensure the laser beam remains centered on the treatment area, even with slight involuntary movements. This tracker requires the eye to be relatively stable and consciously focused on a target, which is compromised under deep sedation. Using general anesthesia also introduces significant, unnecessary health risks, including complications related to breathing, heart rate, and prolonged recovery time. Since the procedure is fast, minimally invasive, and pain-free with topical drops, the risks and increased costs of being fully “put under” far outweigh any potential benefit.