Cataract surgery removes the clouded natural lens and replaces it with an artificial intraocular lens (IOL). The body’s natural response to any surgical intervention is to initiate an inflammatory cascade involving swelling and redness. This inflammatory response is an expected part of the healing process. Managing this inflammation is important for achieving a successful outcome and quick visual recovery.
The Typical Timeline of Inflammation
The most active inflammation peaks within the first 24 to 72 hours following surgery. During this acute phase, the eye’s internal fluid shows the highest concentration of inflammatory cells and proteins. This initial inflammation is generally well-controlled by prescribed medications.
Noticeable surface inflammation, causing redness and swelling, typically subsides within the first week or two. However, intraocular inflammation often requires a more extended period for complete resolution. A milder, residual level of intraocular inflammation can persist for four to six weeks.
For patients with pre-existing conditions like diabetes or a history of uveitis, the inflammatory response may be more prolonged, sometimes requiring anti-inflammatory drops for six to eight weeks. Inflammation is fully resolved only after successfully completing the prescribed regimen of tapering off all anti-inflammatory eye drops. Prematurely stopping medication can lead to “rebound” inflammation, requiring treatment to be restarted.
Recognizing Normal Symptoms and Warning Signs
It is normal to experience mild symptoms as the eye heals. Expected signs include a mild, gritty or scratchy sensation, and slight redness of the eye surface. Temporary, mild blurriness and occasional itching are also common in the initial days following surgery.
Patients must be aware of warning signs that require immediate contact with the ophthalmologist. These signs include a sudden and marked decrease in vision or vision that worsens after an initial improvement. Other concerning symptoms are severe, abrupt pain that is not relieved by over-the-counter medication, persistent nausea or vomiting, and the appearance of a pus-like discharge. Extreme light sensitivity (photophobia) or seeing new flashing lights should also prompt immediate medical evaluation.
Medication Used to Control Inflammation
The surgeon prescribes a specific regimen of eye drops to manage the post-operative inflammatory response. The primary anti-inflammatory medications used are corticosteroids (steroids) and nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid drops reduce swelling and prevent the accumulation of inflammatory cells. NSAID drops, such as bromfenac or ketorolac, reduce inflammation and control pain, also reducing the risk of cystoid macular edema.
Both steroid and NSAID drops are often prescribed together for a comprehensive anti-inflammatory effect. Newer options include sustained-release implants placed during surgery, which deliver a tapering dose of medication over several weeks. Adherence to the prescribed tapering schedule is important for proper recovery, as it prevents a sudden surge of inflammation. Antibiotic drops are also prescribed preventatively to guard against infection.