Cataracts & Post-op Eye Care

What it is. "A cataract is a cloudy area in the lens of your eye (the clear part of the eye that helps to focus light)." StatPearls: "A cataract is a clouding or opacification of the normally clear lens of the eye or its capsule (surrounding transparent membrane) that obscures the passage of light through the lens to the retina of the eye."

Age is the main driver. "When you’re young, the lens in your eye is clear. Around age 40, the proteins in the lens of your eye start to break down and clump together. This clump makes a cloudy area on your lens — known as a cataract." "Cataracts are very common as you get older. In fact, more than half of all Americans age 80 or older either have cataracts or have had surgery to get rid of cataracts." Worldwide, "Cataracts are the world’s leading cause of remediable blindness." You can have them in one or both eyes, "but they can’t spread from one eye to the other".

Other causes. Diabetes: "In a hyperglycaemic state, there is a high level of glucose in the anterior chamber aqueous, which causes glucose to diffuse in the lens. Hence, when glucose is metabolized to sorbitol, sorbitol accumulates inside the lens resulting in secondary osmotic overhydration." Steroids: "The use of corticosteroids may result in posterior subcapsular cataract formation." Trauma is "A most common cause of unilateral cataracts in young adults". NEI adds smoking, heavy alcohol, family history, eye injury or surgery, radiation to the upper body, and a lot of sun.

Where the cloud sits changes the symptoms. Nuclear cataracts shift focus so that "some elderly patients are able to read again without spectacles (the second sight of the aged)." A posterior subcapsular cataract "is located at the nodal point of the eye, it affects the vision profoundly. The patients usually complain of glare, halos, and photophobia." With cortical cataracts "Glare and photophobia are common phenomena".

When. "Surgery is the only way to get rid of a cataract, but you may not need to get surgery right away." "Your doctor might suggest surgery if your cataracts start getting in the way of everyday activities like reading, driving, or watching TV." "Most people don’t need to rush into surgery. Waiting to have surgery usually won’t harm your eyes or make surgery more difficult later."

What happens. "During cataract surgery, the doctor removes the clouded lens and replaces it with a new, artificial lens (also called an intraocular lens, or IOL)." The NHS describes the steps: "Your surgeon may use sound waves (ultrasound) to break up the lens inside the lens capsule. They'll remove the old lens using suction. They'll place a clear plastic lens inside the lens capsule, which will hold the new lens in place." "It's usually done under a local anaesthetic. This means you'll be awake but you should not feel any pain." NHS says the operation "usually takes between 20 minutes and 45 minutes"; NEI says "The surgery lasts about 1 hour and is almost painless."

Same-day, and not both eyes at once. "You should be able to go home on the same day, but do not drive yourself home." "If you have cataracts in both eyes, they'll be treated on separate days." NEI: "usually about a month apart".

Results. "This surgery is very safe, and 9 out of 10 people who get it can see better afterwards." "Some people notice that colors seem brighter after cataract surgery. This is because the artificial lens doesn’t have the noticeable yellow or brown tint your natural lens had from the cataract." Afterwards "you might need a new prescription for glasses or contact lenses to see clearly."

Normal. NHS: "your vision may be blurry for a few hours – this is because of the eye drops used to widen your pupils", "your eye may hurt for a few days", "it may take several days for your vision to improve". NEI: "Your eye may feel a bit itchy or uncomfortable and sensitive to light and touch. After 1 or 2 days, your eye should feel better." "Most people are completely healed 8 weeks after their surgery." Halos, glare and shadows — "These symptoms are known as dysphotopsias" — are common.

Protect. NEI: "You may also need to avoid some activities for a few weeks — like touching your eye, bending over, or lifting heavy things." NHS don'ts: "do not rub your eye", "do not do any heavy lifting or play sports", "do not wear eye make up", "do not get water in your eye", "do not go swimming, even with goggles", "do not drive until your vision is back to normal". A shield: "you may need to use a plastic shield to protect your eye at night while your eye is healing".

Drops for weeks. "You'll be given eye drops to help your eye to heal and prevent infection. You'll usually need to take these eye drops for about 4 weeks." The steroid drop has its own rules: "Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve", "If DUREZOL is used for 10 days or longer, IOP should be monitored.", and steroids "may suppress the host response and thus increase the hazard of secondary ocular infections."

Endophthalmitis. "Endophthalmitis, while rare due to intracameral antibiotics, is one of the most severe complications post-cataract surgery." "Patients typically present within two weeks after surgery with decreased visual acuity, red-eye, and pain." "Hypopyon is commonly present, around 80% of the time." It "is a vision-threatening ophthalmic emergency that requires prompt diagnosis and immediate treatment." Do not rely on pain: "although pain is an important diagnostic feature, it may be absent in up to 25% of cases." Risk is higher with diabetes and age over 80, and "Patients with poorly controlled blood sugar levels and fever, which may indicate underlying septicemia, are prone to postoperative endophthalmitis." Treatment is urgent intravitreal antibiotics, yet "Even with treatment, outcomes can be severe, including permanent decreased visual acuity to no light perception".

Retinal detachment. A later complication (0.1% to 1.3%), more likely in younger men: "Symptoms typically include flashing lights, floaters, as well as peripheral vision loss with progression to complete vision loss." The NHS lists "floaters (dots and lines) suddenly appear in your vision or suddenly increase in number", "you get flashes of light in your vision", a dark curtain "or shadow moving across your vision", and "your vision gets suddenly blurred" — "These could be signs of a detached retina."

The NEI rule. "Call your eye doctor right away if you notice any of these problems after surgery:" "Vision loss", "Bad pain that won’t go away even if you take medicine for it", "Very red eyes", and floaters or flashes. Treat these as emergencies. (The NHS routes detachment signs to NHS 111; this page follows the more urgent NEI framing.)

The slow one — posterior capsule opacification. "Posterior capsule opacification is the most common late complication." "Secondary cataracts can appear weeks, months, or even years after cataract surgery. The good news is your eye doctor can fix them with laser treatment." The NHS: "sometimes your vision can become cloudy months or years after surgery." For those months-later changes the NHS advice is a non-urgent optician visit — that advice is about late clouding, not a red, painful eye in the weeks after surgery.

Check and clean. "When instilling eye drops, the nurse should perform hand hygiene, apply gloves, and check the same rights of medication administration as done with other types of medication. Prior to administration of eye medication, the patient’s eyes should be assessed for new or unusual redness or drainage." "When cleaning the eyelids, the nurse should clean from the inner canthus toward the outer canthus so as not to introduce debris or dirt into the lacrimal ducts that could cause an infection. A new gauze pad is used for each stroke."

Into the sac, not onto the eye. "The patient should look up and away while the nurse gently uses pressure to pull the lower lid down and expose the lower conjunctival sac. By holding the dropper close to the sac without touching it, the nurse should squeeze the bottle and allow the drop to fall into the sac, taking care to not touch the dropper to the eye." Keep the cap clean: "it should be placed on a clean surface with care taken to keep the inside of the cap sterile and to not contaminate the dropper tip."

Then close and press. "After the eye drop has been instilled, the patient should close their eye. The nurse should apply gentle pressure to the inner canthus, when appropriate, to prevent the medication from entering the lacrimal duct and causing a possible systemic reaction to the medication." And no rubbing.

Ointment. Open RN: "Administering eye ointment follows the same procedure as administering eye drops, except that instead of drops, ½ inch of ointment is placed in the lower conjunctival sac. When applying the ointment, the nurse should start at the inner canthus and move outward." Patients "may experience blurry vision for a few minutes until the medication is absorbed." For the steroid emulsion, remove contact lenses before a dose; "Lenses may be reinserted after 10 minutes following administration of DUREZOL".