The fear that eye surgery will cause intense pain is a common concern for people considering a procedure. Modern ophthalmic surgery, including common procedures like LASIK and cataract removal, is rarely a painful experience. Advances in anesthesia and surgical techniques ensure patients are kept comfortable. Any sensation felt is typically described as pressure or discomfort rather than actual pain, and sensation management begins well before the procedure starts.
Preventing Sensation Before and During Surgery
The primary goal of the surgical team is to block the transmission of pain signals to the brain. For many surface procedures like LASIK or PRK, a local anesthetic is administered as topical eye drops. These drops quickly numb the cornea and conjunctiva, allowing the patient to remain awake and responsive while eliminating sharp pain.
For more involved procedures, such as cataract surgery or some retinal surgeries, a deeper form of anesthesia may be used, sometimes involving local anesthetic injections. These injections, known as an eye block, deposit the numbing agent around the eye to immobilize the eye muscles and block pain signals from deeper structures. Long-acting numbing agents, such as bupivacaine, are often mixed with fast-acting agents like lidocaine to ensure pain relief lasts for several hours after the surgery is complete.
In addition to local numbing, many patients receive a mild sedative, either orally or intravenously, to manage anxiety. This “twilight sedation” does not block pain but helps the patient relax and remain still during the procedure. The combination of targeted local anesthesia and mild sedation creates a calm and pain-free experience for the vast majority of patients.
Expected Sensations During the Procedure
While the pain receptors are effectively blocked by the local anesthesia, other sensory nerves are not, meaning you will still perceive certain feelings during the surgery. The most frequently described sensation is a feeling of pressure, particularly when the surgeon uses an instrument to stabilize the eye or to create an access point, such as during the creation of the corneal flap in LASIK. This pressure is often likened to a strong push on the eye rather than a painful squeeze.
Patients may also notice a tugging or pulling sensation as the surgeon manipulates the eye’s tissues, especially during cataract or more complex procedures. Because the eye is held open by a small eyelid speculum, patients may feel a slight stretching sensation around the eyelids. These mechanical sensations are transmitted through touch and pressure receptors.
Visual sensations are also common, including the perception of bright, flashing lights or abstract colors, especially during laser treatment. The retina interprets the intense light from the surgical microscope and laser as various light patterns. If any sensation moves beyond pressure or mild discomfort into actual pain, patients are instructed to alert the surgical team immediately for more numbing medication.
Managing Discomfort During Recovery
The period immediately following surgery is when the local anesthetic begins to wear off, and this is typically when patients first experience noticeable discomfort. This post-operative sensation is usually a foreign body feeling, often described as a grittiness, burning, or scratchiness, similar to having an eyelash stuck in the eye. For surface procedures like LASIK, this discomfort usually peaks within the first three to six hours and subsides significantly within the first 24 to 48 hours.
Discomfort is managed proactively with a combination of prescribed medicated drops and over-the-counter oral pain relievers. Surgeons frequently prescribe anti-inflammatory eye drops, such as non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, which reduce swelling and help control pain at the source. Acetaminophen is recommended for mild aching, while stronger medications are rarely needed.
Patients are advised to rest with their eyes closed for several hours after the procedure, as this minimizes corneal irritation and aids the initial healing process. Cold compresses can also be applied to the outside of the protective eye shield to soothe the area and reduce swelling. While a mild, dull ache is normal, severe, sharp, or worsening pain is not. Any sudden increase in pain, especially days after the surgery, should prompt an immediate call to the eye surgeon.