AFTER YOUR CATARACT OPERATION

After your cataract operation

After your operation you will return to the ward or day case area where a nurse will explain this information sheet and any specific instructions to you before you go home. 

If after your operation your eye is visible and covered with a clear plastic eye-shield, you will be asked to start your eye-drops the same day, about 4-6 hours after you leave the hospital.

If after your operation your eye is covered with an eye-pad (white) and plastic eye-shield you will usually be asked to remove the pad after 4-6 hours and then start your eye-drops. However, if you are due to be reviewed by your consultant the following day you may be asked to leave the pad in place until you are seen.

Regardless of whether you simply have an eye-shield or pad and eye-shield placed at the end of your operation, you should continue to wear the clear eye-shield for the rest of the operation day and overnight. Thereafter the shield only needs to be worn at night for the next 2 weeks. It should be washed each morning and taped in place at night with the “pointy” corner directed over the top of your nose and the rim resting upon the bone around your eye and NOT on the eye itself.

Your eye may be a little sticky and messy when you wake-up for the first few mornings. If this is the case, bathe your eye carefully with cooled boiled water from the kettle and a clean piece of cotton wool (or similar). Once your eye has opened, instil your eye-drops as directed.

Your eye may also feel a little gritty and picky following your operation, this is quite normal and nothing to worry about, and usually settles over a few weeks. However, should your eye become frankly painful, the vision deteriorate and be associated with redness, swelling of the eyelids and a purulent (pussy) discharge, you must make urgent (day or night) contact with your consultant by telephone or contact the hospital (numbers provided).

If you normally take other eye-drops for either glaucoma or ocular hypertension you MUST continue to use these as you have been previously directed. Should you need to instil more than one different eye-drop at about the same time of day, separate them by about 5-10 minutes so that the second drop does not wash out / dilute the first. If you take artificial tear eye-drops, you may find that you don’t need them whilst you are using your post-operative eye-drops but you may find them helpful as the post-operative drops come to an end. If you do require your artificial tear eye-drops please start a NEW bottle after your operation.

Your sight will usually improve within 2-3 days, although complete healing may take several weeks. Whilst you may see quite well without glasses you need to remember that you will probably require new glasses in order to obtain the best vision from your eye. You should only get new glasses after you have finished the post-operative eye-drops and after you have seen the consultant if this is arranged.

When you return home after your operation it is a good idea to have some help available if you can, especially if you find it difficult to instil your eye-drops. You will need to take life easy for a couple of weeks so that your eye can heal.

Your post-operative appointment will be made automatically, usually about 3-5 weeks after your operation and you will receive written notification about this. If you live a long way from the hospital, your consultant may allow you to see your own optician for follow-up, provided that you have completed your course of eye-drops, that you don’t have other eye disorders, and you are happy with this arrangement. Please note that when you do attend for your post-operative appointment your eyes will be dilated and you will need someone to drive you home.

Expectations following cataract surgery

Spectacle requirements:

The usual objective of cataract surgery is to leave your eyes approximately normal sighted for distance. However, despite this objective, the nature of the measurements, calculations and the surgery mean that the optical outcome is not completely precise. You therefore need to expect to wear glasses to obtain best vision at all distances, including distance vision. Without correct glasses you may be aware that your vision is a little blurry, ghosted or doubled – effects which may vary with viewing distance.

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However, despite these uncertainties some people (perhaps 1 in 10) may find that they can perform many of the tasks of daily living without glasses but it remains important that you understand that this will be more the exception than the rule.

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“Floaters” and “clouds” wafting in front of your vision following surgery:

Some people will notice “floaters” or “clouds” wafting in front of their vision for the first time, or will notice that pre-existing “floaters” or “clouds” are more obvious following cataract surgery. This is because the new clear intra-ocular lens placed in the eye at the time of surgery improves the contrast of the image on your retina (“the film of the camera”) at the back of your eye. This means that edges and shadows are more distinct and that any opacities in the jelly which occupies the inside of your eye (and which are quite common with increasing age) may become more noticeable to you. These “floaters” and “clouds” are usually nothing to worry about and usually become less intrusive with time. If however, these “floaters” and “clouds” are completely new to you and are accompanied by flashing lights or other visual disturbances you should arrange to see your optometrist urgently or contact your ophthalmologist for advice.

Peculiar / unexpected optical effects of cataract surgery = dysphotopsias:

The development of smaller, high refractive index, “sharp-edged” intra-ocular lenses (the lenses that are placed in your eye during cataract surgery to replace your cataractous lens) - has resulted in some patients being aware of optical effects following their surgery that they had not anticipated.

These effects include, but are not limited to the following:

• Awareness of unexplained glints / lights,

• Awareness of unexplained edges,

• Awareness of unexplained shadows,

• Awareness of unexplained lines,

Please note:

• Most of these effects are noted in the peripheral vision on the opposite side from the nose.

• These effects are usually accompanied by otherwise good vision.

Most people are not too troubled by these effects and in time get used to them and forget about them.  Some of these effects are also thought to resolve as the eye’s tissues grow to support the intra-ocular lens.

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However, these effects can initially be a little disconcerting and some patients worry and require reassurance that all is well. If having read this information you remain concerned about your vision please contact your optometrist or your ophthalmologist for advice.

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Watery eyes

It is quite common for your eye to water following your cataract operation. Watery eye symptoms often seem to occur as the post-operative eyedrops are tapered. The watering is nothing to worry about and usually settles over a period of a few months but occasionally it can persist. We are not sure why eyes water following cataract surgery but there are several possible explanations including;

• The eye may behave as if it is a little “dry” after your operation due to the division of some corneal (cornea = clear membrane over the front of the eye) nerves at the time of surgery. Paradoxically this “dryness” may cause a little watering.

• Your post-operative eye-drops are used to reduce inflammation. One effect of this is to make the surface of your eye more “comfortable”. Therefore, as the eye-drops are tapered your eye returns to its usual state and the eye may respond by watering a little for a while.

• Blocked tear drainage passages – this is likely to be incidental and unrelated to your surgery. It is not uncommon for this to occur with increasing age. Usually if a blockage is the cause of your symptoms they will not improve with time.

• It is possible having had an operation upon your eye that you are a little more conscious of the eye and notice changes that you may not otherwise have attributed to anything in particular.

• Allergy. It is possible to develop an allergy or intolerance to your post-operative eye-drops. Should this occur your eye is likely to become red, sore and may itch. Instilling the eye-drops frequently results in more than trivial discomfort. Should this be the case please contact your ophthalmologist or the hospital for advice.

Treatment: Whilst the watering usually settles and become less troublesome with time, some people find the instillation of an artificial tear eye-drop beneficial. These are available over the counter in supermarkets, chemists and opticians and can be used as often or infrequently as required and for as long as required.

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Note: There are many reasons why an eye can start watering most of which are unrelated to cataract surgery. If your eye continues to water and this troubles you, or you notice a lump just below the inner corner of your eye, please contact your GP or optometrist for assessment and referral.

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What to do about “old” and “new” glasses?

• You may wear your “old” glasses or dispense with them if your vision is better without – whatever you find best. Some people choose to have their operated eye spectacle lens removed immediately following their operation (some have a plain lens inserted by their optometrist) in order to wear their “old glasses” and try to make best use of both eyes.

• New glasses are usually prescribed 4-6 weeks after the operation when the eye has optically stabilised. You may however, choose to update your lenses sooner than this to allow more rapid visual rehabilitation, BUT you must understand that if you do so that you may require a further spectacle lens update at 4-6 weeks.

When to resume driving?

• You may resume driving provided that:

1 - you are able to read a car number-plate in good daylight, with glasses if worn, from a distance of 20 metres, with both eyes open,

2 - that your eyes and vision feel comfortable,

3 - that you are not experiencing any double vision

However, it may be sensible to avoid driving for the first 2 weeks to allow you to get used to your new vision. It is advisable to inform your insurance company, although this may not be required.

Back to Work?

• How long you are off work will depend on the job you do. As a guide, people who work in an office environment can usually return to work in 1-2 weeks, for those involved in heavy manual work or where there is a physical or contamination risk, it is better to wait until your eye-drops finish (about 4 weeks). Talk to your eye surgeon if you have any questions.

Other Do’s and Don’ts…

• Avoid touching, rubbing or bumping your eye as the wound is delicate.

• Wear the plastic eye-shield provided at night for the first 2 weeks – wash it each day in clean soapy water.

• Do not do any heavy lifting and avoid strenuous exercise and swimming for 4 weeks.

• You can perform light housework or cooking.

• You should keep yourself mobile.

• You can read and watch television as normal.

• You do not need to stay indoors but take care if it is windy, in case anything blows in your eye.

• Wash your hair leaning backwards rather than forwards for the first 2 weeks and avoid getting soap or shampoo in your eye.

• Avoid eye make-up for 4 weeks.

• You can resume your sex life 2 weeks after the operation.

Your post-operative eye drops:

You will be given some drops to instil in your eye:-

4 x a day for the first week

3 x a day for the second week

2 x a day for the third week

1 x a day for the fourth week.

These drops are very important. If you should run out of drops you must contact your GP to obtain some more as soon as you can.

YOU MUST SEEK URGENT MEDICAL HELP SHOULD:

1. YOUR VISION DETERIORATE

2. YOUR EYE BECOME PAINFUL

3. YOUR EYE BECOME RED

4. YOUR EYE BECOME STICKY

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If you are concerned about your eye you should ring [day or night]:-

The Sancta Maria – 01792 479040

Secretary – 01792 391122 / 07935 281033

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EYE DROP CHART - SEE BELOW

This chart is provided as an aid to instilling your eye-drops.

We suggest that you record the date of your operation at the top (as a reminder) and tick the relevant box(es) once you have instilled each drop.

It is important to make sure that at least 1 drop goes into your eye. Usually the eye will sting slightly or you will feel the cold of the drop when it goes in. Typically this will mean 1 or 2 drops on each occasion.

DATE OF YOUR OPERATION = ___/__/20___