Are there particular sleeping positions that should be avoided after cataract surgery? It's not that quite bizarre of a question. It does seem to make sense. Maybe it's problematic sleeping on the eye that just had surgery.
But rest assured that after cataract surgery, if you are following the instructions appropriately, you can sleep any way you want. Because of the eye shield that you will wear after cataract surgery, you can sleep in any position (even including sleeping on your side), without worrying about applying any extra pressure on the eye.
But let’s look at why pressure should be avoided after cataract surgery and the best way to apply that eye shield.
What Should Be Avoided
Cataract surgery is performed entirely without any sutures or stitches. The tiny micro-incisions used during cataract surgery just simply don’t need them to seal up - they are self-sealing.
Avoiding the need for stitches allows for a quicker procedure and quicker vision recovery after cataract surgery.
But technically, having a stitch in the cataract incision would actually make it stronger in the early post-operative period after cataract surgery. This is the trade-off to having that quicker vision recovery.
Because the cataract incisions won’t be fully strong immediately after cataract surgery, it is important to avoid certain activities to keep them from leaking. A leaking cataract incision can create a potential entry point for bacteria into the eye and increase the risk of an infection from developing.
So we want to prevent the cataract incision from leaking. Fortunately, it is relatively easy to prevent this from happening. Apart from avoiding large pressure swings in the eye by avoiding weight lifting and strenuous activity, the other main way to keep the cataract incision from leaking is to simply avoid applying direct pressure to the eye. Don’t rub or push in on your eye!
Precautions While Sleeping
It’s all easy to say to avoiding putting pressure on the eye while awake, but during sleep you lose a certain amount of control over your actions.
Because of this, after cataract surgery, for the first week or two, you will protect the eye while sleeping to avoid accidentally rubbing or putting pressure on the eye. This is commonly done with a plastic eye shield.
Eye Shield; Image courtesy of Amazon.com
When the eye shield is placed properly, you really don’t have to worry about whichever position you like to sleep after cataract surgery. You can sleep on your back, stomach, sides, even the side that just had the surgery. You can sleep with the head of the bed flat, you can sleep with the head of the bed elevated. (Although I wouldn't sleep with the feet higher than the head - that can increase the pressure in the eye)
When properly placed, the eye shield will completely protect the eye from any excess added pressure in any sleeping position.
This is good news, because let’s face it, you may not be able to control shifting from position to position while sleeping.
But it is important to place the eye shield properly.
Placing the eye shield properly
Most designs of this eye shield have a slight taper at the edge. This taper gets positioned just above the bridge of your nose in order for the shield to fit more comfortable over your face.
But the eye shield won’t stay just on its own (it is just a plastic thing). It needs to be secured with medical tape. Paper surgical tape will be more comfortable, however, the transparent surgical tape can be stickier.
There really are many different ways the eye shield can be taped over the eye. But feel free to be generous with the tape.
When taping the eye shield, the most important method is to follow the contour of the eye shield and your skin. That way the tape sits flush and tight with the skin. If the tape runs against the contour, it will be come loose and the eye shield will shift around.
Run some strips parallel to the tapered end and the opposite side of the eye shield but curing along the edges to form the shape of a diamond. Another alternative is to use the tape to form a V-shape ending at the tapered end. Experiment to see what works best for the shape of your face. Be sure to have good overlap with the skin to make sure the tape stays stuck while you sleep.
For in depth instructions on the best way how to use the eye shield, watch this helpful video:
Don’t worry if the tape ends up blocking your vision. That’s alright; you are only using the tape and shield to sleep at night. Having the shield secured to your face over your eye is more important that having complete unobstructed vision through the shield.
In general, the eye shield tends to be a better solution than other things such as goggles. This is because the eye shield is taped on. The tape provides a more secure attachment to keep the eye shield from moving around in place on your eye. While goggles have a strap and can work, goggles can also be knocked off in the middle of the night.
Note: An eye mask doesn’t serve the same purpose as the eye shield. An eye mask is soft and won’t protect against any pressure on the eye. However, if you want to wear an eye mask once the eye shield is firmly in place, that works totally fine.
Special Situations - Sleep Aids
In general, most sleep aids are fine after cataract surgery. (And can be useful to fall sleep with an awkward eye shield in place).
If you need a melatonin or Ambien to fall asleep, those medications won’t cause any issues with the cataract surgery.
However, some sleep aids will cause the eye to dry out more. This includes Benadryl (also known by the generic name diphenhydramine). These are best avoided after cataract surgery.
Special Situations - CPAP
Wearing an eye shield can also be done even in a CPAP is required to sleep at night. The eye shield is simply secured before the CPAP mask is placed over the face.
However, sometimes the CPAP mask can leak. This can cause air to blow into the eyes. Air blowing into the eyes can cause the eyes to dry out more. You may have had this problem even before cataract surgery; but having an additional eye shield thrown into the mix can make it more difficult to get a tight seal on the mask.
To prevent air leaks from drying out the eye, it is helpful to use a lubricating ointment within the eye prior to falling asleep. A small amount of this ointment (about the size of a half of a grain of rice) is applied to the lower eyelid. Blinking smears a coat of this ointment over the eye to protect it from drying out. (this will also blur your vision).
But check with your surgeon. Your surgeon may also wish that you avoid using your CPAP machine during the initial recovery after cataract surgery.
Summary
After cataract surgery, you will use an eye shield to protect the eye from any accidental rubbing or pressure. When properly placed, it doesn’t really matter what sleeping position you sleep in. The eye will be protected even if you sleep on your side.
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