Will I feel any pain during my eye operation?

A big concern during cataract or any ocular or eyelid surgery is pain. The thought of surgery is understandably quite unsettling and this is made worse because most eye surgery is performed under local anaesthetic in a ‘day-case’ setting. The only comparable experience people will have is usually a trip to the dentist….!

Cataract surgery is the most commonly performed operation performed in the NHS and great strides have been made in making the surgery safer, more predictable and allowing a quicker recovery. Anaesthetic technique has also changed over time and currently the most frequent techniques involve using eye drops alone or a blunt-tipped cannula to administer anaesthetic around the eye.

The technique using a cannula has the advantage that it reduces eye movement and squeezing, which in turn makes the surgery safer and has a lower risk of complications. The eye drop (topical) anaesthetic on the other hand has the benefit of a quicker recovery however it may not be quite as effective at blunting pain during the operation.

In addition to the local anaesthetic, it may be possibly to have some oral sedation to make you more relaxed. There is a proven link between anxiety and pain experienced and sedation may reduce anxiety. Most commonly this is given as a tablet but it can also be given through a vein, which can then be titrated to produce a deeper anaesthesia. This would usually require the presence of an anaesthetist to allow monitoring of your vital signs such as heart rate and oxygen levels. General anaesthetic is the deepest form of anaesthetic, where a muscle relaxant can also be given and a tube is required to be placed into the airway, allowing the anaesthetist to control and carefully monitor all the vital functions.

Most simply and effectively however, I firmly believe that a good preoperative discussion and explanation as well as a good rapport with your surgeon, is the best way of alleviating anxiety prior to surgery. My own research has shown the value of having someone hold your hand during surgery in reducing anxiety and in turn reducing the experience of pain. Cataract surgery is a highly specialised and technologically advanced procedure however when it comes to anaesthesia, it comes down to the good old-fashioned values of kindness, empathy, bedside manner and proving a hand to hold!