ICL is a surgery. And while it's a great surgery with lots and lots of benefits; any surgery carries risks of something going wrong. Although the risks with ICL are very low, there are still events that can happen during the ICL surgery or shortly after which can cause problems and even loss of vision.
ICL surgery can cause the pressure of the eye to increase. This can lead to a terrible headache and if left untreated can cause vision loss. ICL can also cause the vision to decline from cataracts. Each of these can require separate procedures to fix.
Fortunately, these aren’t likely to happen. But we are talking about how ICL surgery can go wrong, so let’s explore more in depth about what each of these events mean for your eyes and your vision.
After ICL, the pressure within the eye can increase
If the pressure within the eye increases, this causes a few main symptoms. A severe headache is by far the most common symptom. This headache is occasionally associated with nausea and/or vomiting. In addition to the headache, you can have blurred and foggy vision. Elevated eye pressure is uncomfortable. There are two main things with ICL that can cause this increase in pressure.
Flow of Aqueous Humor within the eye; http://www.nei.nih.gov/photo/eyedis/index.asp, Public domain, via Wikimedia Commons
To see how the eye pressure can increase after ICL surgery let's review where eye pressure comes from in the first place. The front of the eye is filled with a liquid called aqueous humor. This aqueous is produced behind the iris, travels through the pupil and drains out through the angle of the cornea. How much aqueous is in the eye determines the pressure of the eye. If the aqueous can't drain out, then the pressure goes up.
The most common cause of a high pressure after ICL surgery
During the ICL procedure, a thick gel is placed in the eye to protect all the delicate structures. At the end of the procedure, this thick gel is washed out. Any remaining gel in the eye will dissolve on it's own. HOWEVER, if too much of this thick gel remains, it can block the angle and prevent the aqueous from draining out —> causing the pressure of the eye to increase.
Too much gel in the eye is most frequently treated with just extra eye drops and sometimes pills which lower the pressure of the eye. Occasionally in the office, the surgeon may also release some of the extra build-up of fluid in the exam room at the slit-lamp microscope. As the pressure goes down, the headache and the blurred vision gradually get better. And by the next day, this issue resolves on its own (as the remaining gel dissolves).
This common cause (while annoying and stressful), has easy treatments and a straightforward path to resolution.
High eye pressure that requires intervention
But there is another rare cause of the pressure going too high in the eye. The ICL comes in different sizes. These sizes are matched up to the size of the eye. But this sizing isn't perfect. Occasionally, ICL's may be too small or too large for the eye. If the ICL's are too small, cataracts can potentially develop at some point in the future (see also What Are The Long Term Effects of ICL Surgery?). But on the opposite side of things, if the ICL sizing ends up too big, it can also cause the pressure to go too high.
If the ICL is too big, the ICL pushes the iris forward too much and causes the iris to block the draining of the aqueous out of the eye. Very rare for this to happen, but possible. Once again, this causes a bad headache and potentially nausea and vomiting. Treating with eye drops in the office has a harder time lowering the pressure. If the ICL is too large, the solution is to swap the ICL out for a different size. This requires another procedure and is inconvenient. Fortunately, ICLs that are too large happen less than 0.4% of the time.
Either the cause, one way or another, the high pressure within the eye is able to be treated and restored back to normal.
ICL surgery can cause the development of cataracts
The ICL surgery is performed close to the natural lens within the eye. This natural lens can become damaged during the surgery. If this natural lens becomes damaged, it will become cloudy. A cloudy lens will cause you to lose vision; this is called a cataract.
Cataracts require cataract surgery to fix. Fortunately, cataract surgery is a very successful surgery and can still correct your vision, but ultimately we want to avoid extra procedures. With experienced surgeons, however, this almost never happens.
Summary
It is possible to develop issues after ICL surgery. The pressure within the eye can become too high. The natural lens can be damaged by ICL surgery. Either of these events will require additional treatments and potentially additional surgeries to fix. It is possible for things to go wrong with ICL surgery. But fortunately, it just isn’t very common.
Should you be worried about what can go wrong with ICL? As long as you find a good ICL surgeon, then no. The vast majority of potential problems with ICL surgery are issues where the eye pressure increases. While uncomfortable and inconvenient in the short term, these issues are treated and then you're good for the long run.
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