What to Know About Cataract Surgery Complications

Complications can occur during any surgical procedure. With cataract surgery, there are a number of specific complications that will be on your surgeon’s radar.

1. Pain

Pain is an expected complication of most surgical procedures. Since cataract surgery involves only the superficial layers of your eye, over-the-counter pain relievers will generally help. If pain persists or worsens, call your doctor. It could be a sign of a more serious complication.

2. Bleeding

Suprachoroidal hemorrhage can occur in people with diabetes, high blood pressure, or other existing conditions after cataract surgery. This complication is rare but requires immediate care to avoid vision loss.

3. Infection

Most procedures carry some risk of infection from surgical tools, the surgeon’s technique, or wound care after surgery.

Endophthalmitis is an infection you may experience after cataract surgery. It is rare, though, occurring in fewer than 0.5 percent of cataract surgeries.

4. New or continued vision problems

In some cases, cataract surgery may not be effective, and you may continue to have vision problems or worse vision after surgery. This is rare, but it’s more common in people who had other eye conditions beyond cataracts even before surgery.

Double vision — which is usually temporary — can also occur after eye surgery while your brain adjusts to a new, clearer picture.

5. Floaters

Floaters is the term given to tiny particles of protein or collagen that can cross your field of vision and cast shadows. Floaters don’t always need treatment but can sometimes be a sign of a more serious problem.

6. Dry or itchy eyes

As the tissue heals, dryness and itching are common. Your eyes may feel itchy, gritty, or dry. Your doctor may suggest lubricating eye drops to help with this problem. Check with your doctor for when to use eye drops after surgery.

7. Allergic reactions

The use of general anesthesia for cataract surgery is rare, and usually only in pediatric cases. Typically, topical anesthesia delivered by eye drops or local anesthesia with an injection may be used to numb the eye.

Talk to your doctor before surgery if you have any medication allergies.

8. Inflammation

While it isn’t viewed as a true complication, but rather an expected result, “cell and flare” is inflammation caused by a slight trauma to the eye after surgery.

When your surgeon makes contact with your eye, a small amount of white blood cells or protein may build up in the front chamber of the eye, creating blurred vision or light sensitivity. This condition is usually temporary and can be treated with topical steroids.

9. Corneal edema

Again, this is an expected result from surgery, but one that may cause concern. Swelling in the cornea can occur anywhere after surgery, but is usually at incision sites. This condition can be treated with topical steroids that will reduce swelling.

10. Increased pressure

Up to half of those having cataract surgery will experience some increase in pressure in their eye after the procedure, but pressure levels usually return to normal within 24 hours.

Ongoing problems with increased or decreased eye pressure after surgery may be related to other eye conditions, like glaucoma.

11. Iris prolapse

In rare cases, surgery could cause trauma to the iris, resulting in a prolapsed iris. This is sometimes related to poor wound closure or healing at incision sites, or long periods of high pressure in the eye.

Sometimes the iris can be repositioned, but another surgery will be required in more extreme cases.

12. Wound leaks

Another rare complication, wound leaks occur when fluid leaks around the incision sites. These leaks are diagnosed with the use of fluorescein dye, and can usually be treated with steroids.

In some cases, your doctor may apply a bandage contact lens or perform corrective surgery to fix the problem.

13. Toxic anterior segment syndrome

Significant swelling and pain in the days after cataract surgery may signal this complication. Toxic anterior segment syndrome is a very rare infection often caused by contaminated surgical equipment or eye drops.

High doses of steroids and pain relievers are used to treat this condition, which can be difficult to differentiate from endophthalmitis.

14. Early acute endophthalmitis

This is another type of infection that causes swelling and pain, and can occur 3 to 7 days after surgery. Steroids don’t work to fight this eye infection. It usually requires antibiotics or a referral to a specialist.

15. Retained lens fragments

In some cases, there may be tiny pieces of your natural lens left behind after cataract surgery. These can appear days or even years later in the form of:

• blurry vision
• light sensitivity
• tearing
• redness

If lens fragments are the culprit, they should be surgically removed — ideally by the original surgeon who performed the procedure.

16. Posterior capsular opacification

This is a late complication that occurs in 14 to 60 percent of cataract surgeries. Most common in people who have diabetes or who have had prior eye surgeries, this condition results in the formation of tiny particles trapped in the layer behind the lens.

These particles form tiny clear bubbles called Elschnig’s pearls. A procedure called laser posterior capsulotomy can correct this problem.

17. Cystoid macular edema

This is the most common complication of most cataract surgeries and appears up to 8 weeks after the procedure. It occurs in 1 to 2 percent of all cataract surgeries.

Swelling is caused by the buildup of fluid in the eye that can lead to decreased vision. Steroid and nonsteroidal topical treatments are usually used to treat this condition, which can take up to 2 months to resolve.

18. Intraocular lens dislocation

After cataract surgery, there is a chance that the intraocular lens that replaces the natural lens could shift or move. A rare complication, this happens in roughly 0.2 to 3 percent of all cataract surgeries, and frequency has decreased as lens designs improved over the years.

Blurred vision is a common symptom, and this may have to be repaired surgically.

19. Retinal detachment

This is a serious complication that occurs mainly in younger patients who have other eye problems or who have had dislocated intraocular lenses.

Retinal detachment requires immediate medical care.

20. Capsular contraction syndrome

This extremely rare complication occurs in just 0.004 percent of cataract surgeries. The remaining natural lens cells create a fibrous material that contracts, reducing the size of the thin membrane that surrounds the lens.

This problem is usually fixed with tiny incisions to relax the membrane around the lens and create more space.

21. Chronic corneal edema

Improved surgical techniques have reduced this complication from about 1.5 percent in the 1980s to around 0.1 percent today. This complication can result in chronic irreversible swelling of the cornea.

There are a number of risk factors for developing this condition, including a history of Fuchs’ dystrophy.

There are a few types of cataract surgery. They include:

• Phacoemulsification. A tiny incision is made in the front of the eye, and a tool that emits ultrasound waves is used to break the lens apart to remove the cataract. A new lens is inserted once the cataract is removed.
• Extracapsular surgery. A long incision is made in the cornea and the natural lens with the cataract is removed. The natural lens is then replaced with an artificial lens placed into the eye. There are also variations on this method using microincisions or lasers for faster healing and fewer complications.
• Intracapsular surgery. This is the oldest method of cataract surgery and is the least used today. It uses the largest incision and manual removal of the old lens. This method has the highest rate of complications due to the size of the incision used.

In most cases, you should see improvement in your vision in a few days — at least when it comes to cataracts. It can take up to a month to heal fully after surgery, and you will need a revision to your eyeglasses prescription once your eyes adjust to their new normal.

Most people are able to return to work and begin driving within a few days of cataract surgery, but there are some activities you should avoid.

Mostly, these restrictions involve reducing pressure on your eyes and avoiding exposure to things that could irritate them and slow healing.

Some tips for cataract recovery include:

• limiting exercise and heavy lifting
• avoiding rubbing your eyes
• wearing sunglasses when you are in bright places
• showering carefully and avoid getting soap or water into your eyes
• avoiding cosmetics and creams around the eyes for at least a week
• not swimming or using a hot tub or sauna
• avoiding irritants like chemicals and dust

Some of the complications of cataract surgery aren’t as much of a complication as they are expected side effects. Most of these last for a short time after surgery and aren’t cause for alarm or serious treatment. Side effects can include:

• blurry vision
• itching
• dryness
• redness
• soreness or pain
• swelling
• floaters
• light sensitivity
• a visual “halo” effect around lights

Your doctor may prescribe eye drops to help with these side effects after surgery.

With symptoms of normal side effects and serious complications being so similar, you may wonder when it’s worth calling your doctor after cataract surgery. While your doctor should give you specific advice on when to call for help after the procedure, some signs to watch for include:

• pain that isn’t helped by prescribed or over-the-counter medications
• vision loss
• fever
• nausea or vomiting
• dark spots in your vision

Cataract surgery is one of the most commonly performed surgical procedures. Over the years, improvements made to surgical techniques and lens implants have reduced the risk of complications.

Like any surgical procedure, cataract surgery comes with some side effects. Be sure to talk with your surgeon about what to expect after the procedure, and when to call for help.