Avoiding strenuous activity may be easy for some. But for others who routinely workout and push their body to become stronger and faster, avoiding activity after cataract surgery is a tough ordeal. But not all activity is risky. In particular, there is a one situation we want to avoid.
After cataract surgery, we want to prevent infection. This is best achieved by avoiding fluctuation of pressure within the eye. During strenuous activity, the pressure inside the eye can go up and down due to something called the Valsalva maneuver. This happens with lifting weights but also with activities that require a short burst of power.
Any strenuous activity that involves bursts of power should be avoided after cataract surgery. Let’s see exactly why.
Trying To Prevent Infection
Today’s cataract surgery is performed entirely without any sutures or stitches. This is great! By eliminating stitches, cataract surgery enjoys a much quicker recovery time.
So instead of using stitches, cataract incisions are created to be watertight. At the end of the surgery, water pressure is used to push the edges of the incision together and seal it up.
The goal after surgery is to keep this incision sealed up. We obviously want to prevent any leaks. But a leaking incision also creates another issue. If a cataract incision opens up (even if ever so slightly and temporary) after cataract surgery, it can serve as a pathway for bacteria sitting on the surface of our eye to invade inside the eye. The inside of the eye doesn’t have any normal bacteria; the invading bacteria can take advantage of this and grow, causing damage to the eye.
After cataract surgery, we want to prevent any infection from developing.
Causes of leaky cataract incision
A cataract incision is designed to be watertight at a normal pressure within the eye. The pressure inside the eye pushes the cornea outward closing off the cataract incision.
If the pressure inside the eye fluctuates, the normal architecture of the cornea, and thus the incision changes causing it to potentially leak.
- High pressures (especially when very high) can by brunt force push fluid out of the eye through the cataract incision.
- But more commonly, low pressures distort the cataract incision and cause it to gape open. This allows free passage for outside bacteria into the eye.
So after cataract surgery, we want to avoid high pressures and low pressures. In essence, we want to avoid large fluctuation of pressure after cataract surgery.
Directly pushing in on the eye is sure to cause fluctuations in pressure. But there are large influences outside of the eye as well. The biggest one is from something called the Valsalva maneuver; and this is the issue with strenuous activity after cataract surgery.
The Valsalva Maneuver
Ever swim to the bottom of a pool and develop pressure in your ears? To relieve that pressure you pinch your nose with your fingers and blow to “pop" the pressure in your ears. Or you probably have done the same technique when a plane is descending with or without pinching your nose.
What you are doing during these instances is the Valsalva maneuver.
The Valsalva maneuver; image by U.S. Air Force photo by Airman 1st Class Kate Thornton, Public domain, via Wikimedia Commons
When you attempt breathing out against a closed airway or glottis (the opening between our vocal chords), you are performing a Valsalva maneuver.
Attempting to blow air out without actually releasing any air increases the pressure in our chest. This pressure increase can actually increase the pressure in our brain and eyes.
Thus, performing the Valsalva maneuver can increase the pressure inside our eyes; increasing fluctuation of pressure.
Other than intentionally performing the Valsalva maneuver, here are other common causes of it:
- Coughing
- Vomiting
- Playing a wind instrument
- Lifting
Strenuous Activity (Especially Lifting)
Because we want to avoid fluctuation of pressure after cataract surgery, we want to avoid the Valsalva maneuver. This is the reason to avoid strenuous activity after cataract surgery. But in particular, we want to avoid lifting.
If you’ve ever worked with a trainer in a gym or seen one on TV, they always mention to develop standardized breathing during an exercise. Slowly breath out during your lift and breath in as you lower the weight back down. This technique is to avoid the Valsalva maneuver.
Why must they tell you this? Because it is way too easy to perform the Valsalva maneuver when lifting heavy objects. It is too easy to become focused so much on lifting the weight that you forget to breathe out. Instead you breathe against your closed mouth / glottis and your pressure goes up.
Avoiding heavy lifting is important after cataract surgery to avoid the Valsalva maneuver. (But lifting in general will still cause the pressure of the eye to increase, just not as much as lifting combined with Valsalva maneuver).
Beyond lifting, the Valsalva maneuver can occur in any situation in which you are pushing your body to the max. Any time you are overly engaged in exertion that you forget to breathe, you run the risk of the Valsalva maneuver. Think short outburst of power. These are activities that don’t require oxygen (known as anaerobic exercises).
Examples:
- weight lifting
- Climbing a steep hill on your bike
- Running sprints on a track or up and down a basketball court, soccer field, etc
- Going for a best lap swimming (but you shouldn’t be swimming anyway immediately after cataract surgery)
- Forcibly swinging a tennis racquet
- High-intensity interval training
NOT Examples:
- Going for a walk
- Jogging
- Leisurely bike ride
- Easy golf swings
Activities with very little short bursts of power (aerobic activities) don’t have the same risk of pressure fluctuation as anaerobic exercises. But still important to avoid going too hard with these activities and having sweat drip bacteria into the eye. Wear an athletic headband as a precaution.
Summary
Having fluctuation in the pressure of the eye increases the risk of developing an infection after cataract surgery. Lifting weights after cataract surgery can cause the pressure inside the eye to increase. But other activities that involve short bursts of power can also increase the risk and should be avoided in the first few weeks after cataract surgery.
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