As clean and efficient cataract surgery has become, it still for the most part requires eye drops as you are healing up. There aren’t many, and it’s not for too long, but its still an important part to make sure the eyes heal up the way they should. Each cataract surgeon will have some slight differences in the way eye drops are using after cataract surgery but there are some typical patterns that are followed.
Typically after cataract surgery, during the first week an antibiotic drop is used four times a day and a steroid eye drop is used two to four times a day (depending on which eye drop). Gradually the amount of the steroid is reduced over the next few weeks. Finally, an NSAID eye drop is typically given for the first month after cataract surgery to take once or twice a day.
For the exact frequency of your eye drops, be sure to consult with your cataract surgeon or pharmacy.
Antibiotic Eye Drops
In general, surgeries require antibiotics afterwards. During surgery, bacteria can potentially get into spaces that are normally bacteria free. While it helps that surgeries are done with sterile techniques, sterile equipment and in a sterile environment, infections can still happen and for that reason, infections need to be prevented.
Antibiotic eye drops actually aren't the main way to prevent infection after cataract surgery. The two ways to prevent infection after cataract surgery are to 1) clean the eye with betadine antiseptic to kill any bacteria before the surgery and 2) place antibiotic medication into the eye at the end of the procedure. There is a lot of evidence that those two steps prevent infections after cataract surgery.
But antibiotic eye drops are probably helpful and most surgeons will still prescribe an antibiotic drop after cataract surgery. Cataract surgeons want to do all they can to prevent any infections.
Antibiotic drops after cataract surgery will most often fall into a class of medication called fluroquinolones. This type of antibiotic has the broadest coverage for the bacteria that can infect the eye. This includes:
- Moxifloxacin or Vigamox
- Gatifloxacin or Zymaxid
- Besifloxacin or Besivance
To provide around the clock coverage, these antibiotic eye drops should be taken four times a day for the first week. Following the first week, the infection risk drops and thus it is no longer essential to remain on these eye drops.
Steroid Eye Drops
Surprisingly enough, our own natural lens is considered foreign to our immune system. Nothing happens throughout your entire life because this lens is contained in its own compartment or capsule.
But this changes after cataract surgery. This capsule is opened up and this lens (which has since become a cataract) is removed. But after cataract surgery, microscopic parts of the cataract can remain behind. This stirs up our immune system.
Normally, the immune system kicking in is a good thing. But after cataract surgery we want to suppress it. Inflammation after cataract surgery can cause extra achiness and discomfort and / or blurry vision.
So to suppress this inflammation, steroid eye drops are taken after cataract surgery.
- Prednisolone Acetate or Pred Forte. taken four times a day
- Difluprednate or Durezol. taken twice a day
- Loteprednol or Inveltys. taken twice a day
Steroid eye drops are taken longer than the antibiotic eye drops to make sure the inflammation goes away and doesn't come back. In addition, the frequency you take steroids decreases as you get further from the cataract surgery. Steroid eye drops need to be tapered off in order to prevent the inflammation from rebounding back after stopping the eye drop.
NSAID Eye Drops
NSAID work well anywhere in the body to control mild pain and discomfort. And the same applies to the eyes as well. While there isn't a ton of pain or discomfort after cataract surgery, NSAID eye drops can help make the process even more comfortable.
But NSAID eye drops have another purpose. These eye drops can actually speed up the recovery of vision after cataract surgery. While they don't affect any long-term outcome after cataract surgery, most surgeons will recommend NSAID eye drops after cataract surgery in order to improve the recovery.
Similar to the steroid eye drops, there are different NSAID eye drops, some newer, some older, that have different doses. Typically these eye drops are taken for the first month after cataract surgery
- Ketorolac or Acular. taken four times a day
- Nepafenac - Ilevro, taken once a day or Nevanac, taken three times a day
- Bromfenac - Prolensa or Bromday, taken once a day
BONUS Eye Drop: Artificial Tears
Not all surgeons will require you to take artificial tears after your cataract surgery, but this eye drop can have significant benefits and improve recovery.
Artificial tears work to replenish the natural tear film on the surface of the eye. These eye drops can also work to wash away any inflammation on the surface of the eye. This improves the overall health of the eye to improve both comfort and vision.
After cataract surgery, there will be extra inflammation on the surface of the eye. In fact, the preservatives in prescription eye drops after cataract surgery can actually contribute to this inflammation (but not enough to stop using those prescription eye drops). As you get further and further from the procedure, this extra inflammation heals up. But using artificial tears can speed up the process.
Preservative-free artificial tears are ideal to use. Because they lack preservatives, these artificial tears will be the most gentle on the eyes. But going preservative-free isn't essential (as long as you are using artificial tears less than six times a day). Using a standard artificial tear that comes in a bottle is still going to be helpful.
Routinely using these artificial tears four times a day after cataract surgery can help speed up your recovery.
Preservative-free artificial tears; Image courtesy of Amazon.com note: As an Amazon Associate I earn from qualifying purchases
How To Use Eye Drops After Cataract Surgery
It may seem pretty straight forward, but using eye drops can be challenging if you've never used eye drops before. Here is the best way to learn how to put eye drops in your eyes:
- Tilt your chin towards the sky, this makes the eye more horizontal and easier to hit with an eye drop.
- Pull down your lower eye lid, this creates a larger landing spot for the eye drop.
- Stare at the tip of the eye bottle. If you are looking at the tip, there is a good chance that your eye is aligned up with the eye bottle.
- Gently squeeze the eye bottle until one eye drop comes out of the bottle. This can take some practice until you get a feel for the exact pressure you need on the eye bottle. The volume of a single eye drop is more than enough for the eye.
Proper technique to put eye drop in eye
If you need to put multiple eye drops in the eye (which you will after cataract surgery), wait at least 3-5 minutes between eye drops in order to allow for the eye drop to absorb into the eye and prevent washing the eye drop out.
Can Cataract Surgery Be Done Without Eye Drops?
As cataract surgery continues to evolve, eye drops may become a thing of the past. In fact, medications already exist which can reduce or eliminate eye drops after cataract surgery.
One common method is to combine all the eye drops into a single bottle. This eliminates the need for different bottles and different dosing schedules.
But going beyond that, antibiotic or steroid medication can be injected into the eye at the end of the cataract surgery. This medication can eliminate antibiotic or steroid eye drops.
An alternative way to provide the steroid medication is through a small implant placed within a pocket in the eyelid called the punctum. This allows for a slow release of steroid as you recover from cataract surgery.
These methods have their advantages but haven't yet become the standard way to treat the eye after cataract surgery.
Also check out Is It Possible To Have No Drops After Cataract Surgery?
Summary
Most patients after cataract surgery will take an antibiotic, steroid and NSAID eye drop. There can be slight differences in how often to take these eye drops after cataract surgery depending on the individual medication. But in general, you can expect to be on some eye drops during the first month after cataract surgery.
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