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Precisely How Long Does It Take To Recover From Cataract Surgery

Precisely How Long Does It Take To Recover From Cataract Surgery

Modern cataract surgery has become highly efficient and sophisticated. What once used to be a lengthy procedure with a long and annoying recovery time has become a relatively straightforward operation with a short recovery.

The recovery after cataract surgery can be neatly grouped into a few different time-frames. Much of the recovery happens within the first 24 hours after the procedure. Beyond this, there are some additional things which will continue to heal up during the first week and beyond until the first few months after the procedure.

So let's look at the whole timeline of the recovery after cataract surgery.

First 24 Hours

You've just been wheeled into the recovery room after having your cataracts successfully removed! Of note, cataract surgery is an outpatient procedure. This means that soon you'll be heading home to rest at your own place.

But during those first twenty-four hours, don't expect your vision to be perfect yet and don’t expect the eye to feel 100% comfortable.

First, let's talk about the cornea

Before we get into what why the vision will be blurry after cataract surgery, we first have to discuss the cornea. Much of what you experience during the recovery after cataract surgery has to do with this tiny transparent structure.

The cornea is the front clear window to our eye. It's composed of multiple layers. One layer is on the inside (called endothelium) which is specifically designed to pump water out of the cornea to maintain its transparency. Another layer is on the outside (called epithelium) and acts like the skin of the cornea to provide protection. The health of these layers are very important to have good vision and comfort at any time and especially after cataract surgery.

Endothelium and epithelium on the cornea

Endothelium and epithelium on the cornea; Image by StemBook (CC BY 3.0) / modified from original

Vision

During cataract surgery, ultrasound energy is used to break up and remove the cataract. This provides a very targeted approach to cataract surgery to limit any damage to other parts of the eye and improve the recovery.

This ultrasound energy, however, can damage or at least stun that delicate endothelium layer. This prevents those endothelial cells from being able to pump water out as well and the cornea becomes swollen. When the cornea comes swollen, vision becomes blurry. Also compounding the issue is that the saline fluid used during cataract surgery may at times spray into the cornea increasing the swelling.

The good news is that for most cataract surgeries, this swelling is minimal and most of it resolves after about a day. Vision sharpens up as the swelling resolves. To prevent the ultrasound energy and the saline from having a big impact on the cornea, a cushioning gel is used during cataract surgery to protect this important layer of cells.

However, having denser cataracts (which need more ultrasound energy and take longer) or having an already weak endothelium layer put the eye at a greater risk for swelling - meaning a longer recovery of up to a week or longer for the swelling to go down. By reducing the amount of ultrasound energy needed, this is one way laser cataract surgery can be beneficial.

But there are more ways your vision can be blurry during the first 24 hours:

  • Your eye will still be dilated. When the eye is dilated, it is possible to have more distortions blurring your vision. This dilation typically will wear off after about 4-6 hours, although it can take longer if stronger dilating drops were used.
  • The front layer of your cornea, the epithelium, often becomes irritated and cloudy. This cloudiness further causes your vision to become more of a haze. Fortunately much of this will heal up after a good night's sleep after cataract surgery. But because this epithelium affects how comfortable the eye will be, let's explore it in our next section…

Discomfort / Pain

The cornea goes through a lot during cataract surgery.

  • First multiple eye drop medications are placed on the surface before cataract surgery to dilate the eye. Eye drops contain preservatives which irritate the eye.
  • Immediately before the surgery, betadine antiseptic is then added. The good news is that it is toxic to bacteria! The bad news is that it is also toxic to the cornea.
  • During the surgery, a controlled injury is made to the cornea (the tiny incisions used to remove the cataract).
  • Also during surgery, the eyelids are held open by an eyelid holder, exposing the cornea and making it more prone to dry out. The surgeon must manually keep the cornea hydrated.
  • And even after surgery, the cornea doesn't get a break. Those prescription medication eye drops you are on for the first month also contain preservatives which will further aggravate the cornea.

The cornea is the most sensitive structure in the body and a healthy epithelium is the reason why we don't have constant pain from the cornea. All of the above make the epithelium “sick”. It's no wonder that the eye will feel more uncomfortable immediately after cataract surgery.

This causes: generalized discomfort, burning, the feeling like there is something in the eye, extra sensitivity to light.

On top of that, the scratch on the eye left over from the incision (plus more if you had special incisions which correct astigmatism), can / will cause some degree of pain.

But fortunately, the bulk of all this heals up very quickly - typically overnight. As you close your eyes to sleep, the epithelium of the cornea is covered and protected from drying out; allowing it to heal up.

And so, the next day out after cataract surgery, the eye typically feels much more comfortable.

But we aren’t quite done with the cornea and epithelium yet, we'll return to this epithelium again, as it takes longer to fully return back to normal…

The First Week Or Two After Cataract Surgery

After the first 24 hours, we've entered the second phase of the recovery after cataract surgery. Vision has gotten better, the eye has gotten more comfortable. (And these two will continue to improve as we'll see).

The second stage of the recovery is focused on preventing any problems that can interfere with healing. For this, there are things you can do and things you shouldn't do.

What Not To Do

During the first week or two after cataract surgery. There are certain activities that should be avoided. (for an in depth review, check out Learn What Activities Should Be Avoided After Cataract Surgery)

It is important to avoid:

  • heavy lifting & strenuous activity
  • bending over
  • rubbing the eye
  • getting the eye wet

Why? Back to the cornea…specifically, the tiny micro-incision that was made to remove the cataract.

One feared complication of any surgery (and especially cataract surgery) is an infection. An infection can seriously damage very delicate parts of the eye such as the retina and lead to a permanent loss of vision. And so, preventing an infection as much as possible is very important.

Normally, bacteria have a very hard time getting into the eye. But having an incision changes all of that. Suddenly, there is a pathway for the bacteria to get through the cornea and into the eye.

Sounds terrible. But not to worry, fortunately, infections are quite rare.

See, there is only a risk for bacteria to get in if

  1. these incisions leak and
  2. there are bacteria on the surface of the eye

Having the pressure fluctuate inside the eye increases the risk that the incision can leak. Activities such as heavy lifting and bending over cause extra fluctuation of the pressure inside the eye.

Also important is to avoid getting extra bacteria on the eye. Thus, keeping the eyes clean and away from sources of bacteria, such as water, is important.

But these restrictions are short lived. Gradually as you get past one to two weeks after the cataract surgery, the tiny-micro incision becomes much stronger dramatically decreasing the risk of anything going in or out.

Vision stabilizes (for most)

You don’t have to wait long for cataract surgery to take effect.

By the first week, the prescription and thus vision stabilizes for most individuals. (in fact, unless you had a lot of swelling the first day or two out, you probably already see well without needing to wait a whole week).

Check out Exactly How Long Does It Take For Vision To Stabilize After Cataract Surgery to learn what can make it take longer.

Now, this doesn’t necessarily mean you’ll see perfect yet, a whole host of things can make your vision still continue to be blurry.

But this does mean that if you have extra prescription, extra astigmatism, or want to get a pair of progressive glasses to see up close, you’ll be able to get an accurate pair of glasses after just a week or two after cataract surgery.

But there’s more to come with improvements in vision up to the first month and beyond…

First Month and Beyond

All that’s left is icing on the cake. Things just continue to improve.

But before we get into the cool way that vision just gets better, we first have to go back to the cornea.

Dry eye after cataract surgery

Remember how that cornea was irritated after cataract surgery? For most, this heals up pretty quickly and the eye starts feeling more comfortable a week or two out.

But for others, this irritation lasts longer and makes the eye more prone to drying out. Approximately 10 to 15% will have extra dry eye after cataract surgery that can last a month or longer. If you had dry eye before cataract surgery, you will probably experience a worsening of your dry eye afterwards for a short while.

This will cause the usual symptoms of irritation, achiness, burning, or the feeling like there is something in the eye.

But dry eye can also affect vision. Specifically, it can cause the vision to fluctuate.

On the surface of the cornea is a layer of tears - called the tear film. These tears protect the cornea from drying out.

When this tear film is good, it is also smooth and clear. Light can pass through easily providing good vision. But if this tear film dries out too quickly, it becomes irregular. This irregular layer of tears scatters light blurring vision.

Right after blinking, the tear film becomes smooth and the vision sharpens only to dry out a few seconds later, causing the vision to become blurry again. The vision fluctuates.

The good news about dry eye after cataract surgery is that it gets better. And by three months out, generally most if not all of this extra dry eye has resolved.

In meantime, it’s a good idea to treat this dry eye with preservative free artificial tears, to encourage healing and prevent it from getting worse.

Improvements in what you see

In some cases after cataract surgery, vision may not seem quite as sharp. Many times, this is due to some other cause such as residual prescription or that dry eye I talked out above. But sometimes vision may feel blurry despite everything else being perfect. And in fact, there is a reason why this is the case.

The way vision works is that light enters the eye and the eye sends this information to the brain. It is then the brain’s job to determine what we see. Vision actually comes from the brain. The eye just is a messenger to the brain.

And our brains are pretty neat. They are capable of adjusting to many things. In fact, before cataract surgery, your brains had decades to adjust to the subtle imperfections in your own eyes and also some time to adjust to the larger imperfections coming from the cataracts.

And then we suddenly remove the cataract and put in a new artificial lens. The brain isn’t used to this and must re-train itself to optimize the vision coming from the new lens. This process is called visual neuroadaptation and takes time; months and months.

As the brain learns how to use the eyes better, vision gets better.

This adjustment process is especially important for some of the more advanced artificial lenses used during cataract surgery to get out of glasses completely or for other techniques such as monovision. These ways of seeing are totally unique to the brain and it has to adjust over time.

Check out Adjusting And Training Eyes After Cataract Surgery to understand more about this topic

Summary

Whether you are a day out, a week out or a month out of cataract surgery, there are still things which are recovering. But most of the recovery after cataract surgery takes place within the first 24 hours followed by the first week. Beyond that the eyes just gradually get a little bit better with time.

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