Author: Dr Val Phua
Estimated reading time: 18 minutes

Cataract surgery is not usually painful.

Before the operation, the eye is numbed using local anaesthesia. Most patients remain awake but should not feel sharp surgical pain. They may still be aware of:

• Bright lights
• Colours or moving shadows
• Cool fluid around the eye
• Gentle pressure
• Touching or movement
• The sensation that something is happening

The exact experience varies. Some patients feel almost nothing, while others notice brief stinging, pressure or mild discomfort during particular parts of the procedure.

The most accurate answer is:

Cataract surgery should not normally cause significant pain, but local anaesthesia does not always remove every sensation. Tell the surgeon immediately if you feel sharp, increasing or intolerable pain so that additional anaesthetic or another adjustment can be made.

Cataract surgery is generally performed as a day procedure. The eye is commonly numbed with anaesthetic drops, sometimes supplemented by anaesthetic medication placed inside or around the eye. Sedation may also be offered to reduce anxiety.

What Happens During Cataract Surgery?

A cataract is clouding of the eye’s natural crystalline lens.

During modern cataract surgery, the surgeon generally:

1. Makes small incisions at the edge of the cornea
2. Opens the front of the lens capsule
3. Divides and removes the cloudy lens
4. Preserves the capsular bag when possible
5. Inserts a clear artificial intraocular lens
6. Checks that the new lens is centred and the incisions are secure

The most common technique is phacoemulsification, which uses ultrasound energy and controlled aspiration to remove the cataract through a small incision.

Why Does Cataract Surgery Not Usually Hurt?

Pain signals from the eye travel through sensory nerves, particularly those supplying the cornea and surrounding structures.

Local anaesthetic temporarily blocks these nerves from transmitting pain signals.

Anaesthesia may be delivered through:

• Anaesthetic eye drops or gel
• Anaesthetic medication placed inside the front of the eye
• A local-anaesthetic injection around the eye
• Sub-Tenon’s anaesthesia
• Sedation combined with local anaesthesia
• General anaesthesia in selected circumstances

The technique is individualised according to the patient, the complexity of surgery and the surgeon’s assessment.

Are You Awake During Cataract Surgery?

Most adults are awake.

Being awake does not mean undergoing surgery without anaesthesia. The eye is numbed, and sedation may be used when appropriate.

Patients usually remain awake because:

• Modern cataract surgery is relatively short
• Local anaesthesia generally provides adequate comfort
• General anaesthesia is unnecessary for most routine cases
• Recovery is usually faster
• Patients can follow simple instructions
• Risks associated with deeper anaesthesia may be avoided

Patients are generally awake during cataract surgery after the eye has been numbed with drops, gel or an injection.

Does Being Awake Mean You Will See the Operation?

Usually not in recognisable detail.

Patients commonly see:

• A bright microscope light
• Changing colours
• Geometric patterns
• Moving shadows
• Changes in brightness
• Brief dimming
• Light becoming clearer after the cloudy lens is removed

Most patients cannot identify the instruments or watch the operation as though viewing a video.

Some patients find the visual experience interesting. Others find the brightness unfamiliar or initially unsettling.

Sedation may reduce anxiety and awareness of the visual experience, although its effects vary between patients.

Types of Anaesthesia for Cataract Surgery

Topical Anaesthesia

Topical anaesthesia uses numbing drops or gel placed on the surface of the eye.

Possible advantages include:

• No anaesthetic needle around the eye
• Rapid onset
• Rapid recovery
• Preservation of eye movement
• Less bruising or eyelid swelling
• Suitability for many routine operations

The patient must usually be able to:

• Lie reasonably still
• Follow instructions
• Avoid sudden head movement
• Communicate with the surgeon

Topical anaesthesia blocks pain from the ocular surface effectively, but the patient may still feel pressure or internal manipulation.

Research comparing topical and injected regional anaesthesia generally finds slightly more intraoperative discomfort with topical anaesthesia, but fewer injection-related effects such as bruising, chemosis and bleeding around the eye.

Intracameral Anaesthesia

Intracameral anaesthesia means that a small amount of preservative-free local anaesthetic is placed inside the anterior chamber of the eye during surgery.

It may be added to topical anaesthesia to improve comfort during manipulation of internal structures.

The patient does not normally feel the medication being placed inside the eye because the surface has already been numbed and the incision has been created.

Sub-Tenon’s Anaesthesia

Sub-Tenon’s anaesthesia involves placing local anaesthetic beneath a thin membrane surrounding the eye.

It can provide:

• Stronger pain relief
• Reduced eye movement
• Greater comfort during longer or more complex surgery

Possible effects include:

• Redness
• Subconjunctival bleeding
• Eyelid swelling
• Temporary double vision
• Temporary reduction in eye movement

Peribulbar or Retrobulbar Anaesthesia

These techniques use an injection of local anaesthetic around or behind the eye.

They may provide:

• Dense pain control
• Reduced eye movement
• Reduced eyelid movement

They may be considered when:

• Surgery is expected to be complex
• The patient has difficulty keeping the eye still
• A longer operation is anticipated
• Topical anaesthesia may be insufficient
• The surgeon requires greater control of eye movement

The injection itself may cause brief discomfort, pressure or stinging.

Regional needle blocks generally provide stronger pain relief than topical anaesthesia but have uncommon injection-related risks, including bruising, bleeding and injury to surrounding structures.

Sedation

Sedation is medication given to help the patient relax.

It may be given:

• By mouth
• Through an intravenous line
• In carefully adjusted doses during surgery

Sedation may make the patient:

• Less anxious
• Drowsy
• Less aware of time
• Less likely to remember every detail
• More comfortable with the surgical environment

Sedation is not the main source of pain control. The eye still requires local anaesthesia.

Patients are not always completely asleep and may still hear the surgeon or follow instructions.

Too much sedation may interfere with:

• Cooperation
• Breathing
• Blood pressure
• The ability to remain still
• Recovery after surgery

The amount should therefore be individualised rather than automatically maximised.

General Anaesthesia

General anaesthesia means the patient is fully unconscious.

It is not routinely required for ordinary adult cataract surgery.

It may be considered for:

• Babies and young children
• Severe uncontrolled anxiety
• Significant cognitive impairment
• Severe movement disorders
• Inability to lie still
• Inability to follow instructions
• Certain complex or traumatic operations
• Patients for whom local anaesthesia is unsuitable

General anaesthesia involves additional medical assessment and its own risks and recovery requirements.

What Does Each Stage of Cataract Surgery Feel Like?

Before Entering the Operating Theatre

Patients may feel more anxiety than physical discomfort.

Common worries include:

• “What if I blink?”
• “What if I move?”
• “Will I see the instruments?”
• “What if the anaesthetic wears off?”
• “What if I panic?”
• “What if I cough or sneeze?”

These concerns should be discussed before surgery.

The eyelids are held open gently during the operation, so the patient does not need to prevent blinking voluntarily.

The patient should tell the surgical team beforehand about:

• Severe anxiety
• Claustrophobia
• Back or neck pain
• Breathing difficulty when lying flat
• Tremor
• Chronic cough
• Hearing impairment
• Previous anaesthetic problems
• Previous painful eye procedures
• Difficulty remaining still

Preoperative education and appropriate management of anxiety can make the surgical experience more comfortable.

Anaesthetic Drops

Anaesthetic drops may sting briefly when first applied.

The sensation commonly lasts only several seconds.

Additional drops may be used to:

• Dilate the pupil
• Reduce infection risk
• Prepare the surface
• Control inflammation

Some dilating or antiseptic preparations may also cause brief stinging.

Cleaning the Eye

The eyelids, surrounding skin and ocular surface are cleaned with antiseptic.

Patients may notice:

• Coolness
• Wetness
• Mild stinging
• Fluid around the ear or side of the face

Antiseptic preparation is an important part of reducing infection risk.

Applying the Sterile Drape

A sterile drape is placed around the eye.

Some patients are initially aware of the drape near the nose or face.

Airflow and positioning are arranged so that the patient can breathe comfortably.

A patient with claustrophobia should tell the team before surgery rather than waiting until the drape is in place.

Inserting the Eyelid Speculum

A small device holds the eyelids apart.

Because the surface has been numbed, insertion is generally not painful, although the patient may notice:

• Pressure around the lids
• A stretching sensation
• Awareness that the eye is being held open

The patient cannot accidentally blink onto the surgical instruments.

Looking at the Microscope Light

The operating microscope produces a bright light.

Initially, this may feel intense.

Vision frequently changes into:

• Coloured light
• Bright patterns
• Shadows
• A hazy or diffuse glow

Patients are not expected to stare perfectly at one point throughout the entire operation. They should keep the head still and follow the surgeon’s instructions.

Creating the Incision

The incision is made through the numbed cornea.

Most patients do not feel cutting.

They may notice:

• Pressure
• A change in brightness
• Cool fluid
• Brief movement

Sharp pain should be reported immediately.

Opening the Lens Capsule

The surgeon creates a circular opening in the front of the lens capsule.

Most patients are not aware of this as a distinct stage.

Separating and Dividing the Cataract

Fluid is placed around the cataract, and the lens is divided into smaller pieces.

The patient may feel:

• Mild pressure
• Fluid movement
• A vague internal sensation

They should not normally experience severe pain.

Phacoemulsification

The ultrasound probe fragments and removes the cataract.

Patients may hear:

• Machine sounds
• Beeping
• Fluid sounds
• The surgical team speaking

These sounds are normal and do not indicate that anything is wrong.

The ultrasound itself is not usually perceived as vibration or pain.

Inserting the Artificial Lens

The folded intraocular lens is inserted and unfolds inside the capsular bag.

Patients generally do not feel the artificial lens entering or unfolding.

Vision may suddenly appear:

• Brighter
• Clearer
• More colourful
• Different in focus

The final clarity is not assessed immediately because the pupil remains dilated and the eye is still healing.

Completing the Operation

The surgeon removes residual viscoelastic, checks the lens position and ensures that the incisions are secure.

The patient may feel:

• Pressure
• Fluid
• Gentle touching

The eyelid holder and drape are then removed.

Can You Feel Pressure Without Pain?

Yes.

Local anaesthesia primarily blocks pain.

It may not eliminate all awareness of:

• Touch
• Pressure
• Movement
• Temperature
• Bright light

Pressure does not necessarily mean that the anaesthetic is failing.

A useful comparison is dental treatment: the area may be numb, yet the patient remains aware that pressure or movement is occurring.

However, patients should not try to decide for themselves whether a sensation is “normal enough.” They should tell the surgeon when it becomes sharp, intense or distressing.

What Should You Do if You Feel Pain During Surgery?

Tell the surgeon immediately.

Do not:

• Suddenly sit up
• Move your head
• Pull away
• Squeeze the eyelids forcefully
• Remain silent because you think pain must be endured

The surgeon may:

• Pause
• Add more topical anaesthetic
• Place intracameral anaesthetic
• Adjust an instrument
• Reduce iris manipulation
• Modify fluid pressure
• Provide additional sedation
• Convert to another anaesthetic technique when necessary

Good communication is part of safe cataract surgery.

Does Everyone Experience Cataract Surgery the Same Way?

No.

Pain perception is influenced by:

• Individual sensitivity
• Anxiety
• Previous surgical experience
• Type of anaesthesia
• Surgical duration
• Cataract complexity
• Pupil size
• Need for iris manipulation
• Pre-existing ocular-surface discomfort
• Ability to relax and cooperate

Research studies report different proportions of patients who notice some pain under topical anaesthesia because:

• “Pain” may include a very mild temporary sensation
• Different pain scales are used
• Anaesthetic protocols differ
• Surgical complexity differs
• Patient populations differ

The clinically important point is not that absolutely no sensation can occur. It is that discomfort is usually mild and manageable, while significant pain should prompt immediate adjustment.

Is the Second-Eye Operation More Painful?

Some patients report that surgery on the second eye feels more noticeable than surgery on the first.

Possible explanations include:

• Greater familiarity with the procedure
• More realistic expectations
• Less novelty or distraction
• Differences in sedation
• Biological inflammatory responses
• Differences in surgical complexity
• Natural variation in pain perception

Systematic reviews have found a tendency towards higher patient-reported pain during second-eye cataract surgery, although the average difference is generally small and not every patient experiences it.

A comfortable first-eye experience does not guarantee that the second eye will feel identical.

Similarly, mild discomfort during the first operation does not mean the second operation will be painful.

What May Increase Discomfort During Surgery?

Anxiety

Anxiety may increase:

• Muscle tension
• Awareness of sensation
• Heart rate
• Blood pressure
• Difficulty keeping still
• Perception of pain

Clear explanations, reassurance and appropriately selected sedation can help.

Small Pupil

A small pupil may require:

• Additional medication
• Iris hooks
• A pupil-expansion ring
• Mechanical manipulation

Manipulation of the iris may be more noticeable because the iris is sensitive.

Patients with small pupils who require iris-expansion devices may benefit from a stronger local-anaesthetic technique.

Dense or Complex Cataract

A dense cataract may require:

• More ultrasound energy
• More manipulation
• Longer operating time
• Additional instruments

This does not necessarily mean the surgery will be painful, but the anaesthetic plan may need to account for greater complexity.

Weak Lens Support or Previous Trauma

Previous trauma or weak zonules may require additional stabilising devices or alternative lens positioning.

The surgeon may choose stronger local anaesthesia when a longer or more complex operation is expected.

Pre-Existing Eye Pain or Dry Eye

A patient with:

• Severe dry eye
• Corneal sensitivity
• Chronic ocular pain
• Recurrent corneal erosion
• Neuropathic pain
• Active inflammation

may be more sensitive before and after surgery.

The ocular surface should be assessed and treated before surgery where possible.

Is the Anaesthetic Injection Painful?

When an injection block is used, the injection may cause:

• Brief stinging
• Pressure
• Fullness around the eye
• Temporary discomfort

Anaesthetic drops may be applied first, and sedation may reduce anxiety.

Some patients experience more discomfort during administration of an injected block but similar or less discomfort during the operation itself compared with topical anaesthesia.

The trade-off is therefore:

• Topical anaesthesia: less discomfort during administration but slightly more awareness during surgery
• Regional block: more discomfort during administration but denser surgical anaesthesia and reduced eye movement

The best choice depends on the patient and operation.

Will the Anaesthetic Wear Off Before Surgery Ends?

Local anaesthetics are selected and dosed to last through the anticipated procedure.

The surgeon can give additional anaesthetic if required.

Operations that become unexpectedly prolonged may require:

• Additional topical anaesthetic
• Additional intracameral anaesthetic
• Supplementation of a local block
• Additional sedation
• A change in surgical strategy

Patients should report increasing discomfort rather than waiting for it to become severe.

What Does the Eye Feel Like After Cataract Surgery?

Common early sensations include:

• Grittiness
• Mild scratchiness
• Watering
• Light sensitivity
• Mild aching
• Awareness of the eye
• Mild eyelid tenderness
• A sensation similar to an eyelash in the eye

These symptoms may arise from:

• The small corneal incision
• Antiseptic preparation
• Temporary tear-film disturbance
• The eyelid speculum
• Postoperative inflammation
• Dry eye
• Prescribed drops

They should generally be mild and improve rather than become progressively worse.

How Much Pain Is Normal After Cataract Surgery?

Mild discomfort is common.

Severe pain is not.

A patient may reasonably notice:

• Mild irritation
• Slight aching
• Grittiness
• Watering
• Light sensitivity
• Tenderness around the eyelids

Patients should contact their eye doctor promptly for severe pain that does not improve with medication, particularly when it is accompanied by visual loss or marked redness.

Why Can the Eye Feel Gritty After Surgery?

Ocular-Surface Dryness

Cataract surgery temporarily affects the corneal nerves and tear film.

Dryness may cause:

• Burning
• Grittiness
• Foreign-body sensation
• Fluctuating blur
• Watering
• Light sensitivity

Dry-eye changes may persist for several months in some patients, although their severity and duration vary substantially.

Patients with dry eye before surgery are more likely to notice postoperative surface discomfort.

The Corneal Incision

The small incision may produce temporary sensitivity while the surface epithelium heals.

Eyedrops

Postoperative medication may cause:

• Brief stinging
• Irritation from preservatives
• Temporary blur
• An unpleasant taste at the back of the throat

Patients should not stop prescribed drops without consulting the surgeon.

Eyelid Speculum and Antiseptic

Holding the eyelids open and preparing the surface can temporarily irritate:

• Eyelid skin
• Conjunctiva
• Tear film
• Corneal epithelium

How Is Normal Postoperative Discomfort Treated?

Treatment depends on the cause and the surgeon’s protocol.

It may include:

• Prescribed steroid drops
• Prescribed non-steroidal anti-inflammatory drops
• Lubricating drops
• Preservative-free artificial tears
• Oral pain relief when appropriate
• Treatment of raised eye pressure
• Adjustment of irritating medication
• Management of dry eye or eyelid disease

Patients should check before taking oral pain medication when they have:

• Medication allergies
• Kidney disease
• Liver disease
• Gastric ulcers
• Blood-thinning treatment
• Other relevant medical conditions

Is Paracetamol Usually Enough?

For ordinary mild postoperative discomfort, simple pain relief such as paracetamol may be sufficient when it is safe for that patient.

However, needing repeated or strong pain medication after routine cataract surgery should prompt contact with the clinic rather than simply increasing the dose.

Pain treatment should not mask:

• Infection
• Markedly raised eye pressure
• Corneal abrasion
• Significant inflammation
• Wound problems

Follow the surgeon’s medication instructions and the dosing advice on the product or prescription.

Can Cataract Surgery Cause Persistent Pain?

Persistent pain is uncommon but possible.

Some patients develop prolonged symptoms resembling dry eye, including:

• Burning
• Wind sensitivity
• Light sensitivity
• Aching
• Foreign-body sensation
• Pain disproportionate to surface findings

Persistent postsurgical pain may present as dry-eye-like symptoms after cataract surgery.

Risk may be greater in patients with:

• Pre-existing non-ocular chronic pain
• Anxiety
• Depression
• Neuropathic pain characteristics

Persistent discomfort should not be dismissed automatically as normal healing.

Assessment may include:

• Ocular-surface examination
• Tear-film assessment
• Eyelid-gland evaluation
• Corneal staining
• Review of medication toxicity
• Eye-pressure measurement
• Examination for inflammation
• Evaluation for neuropathic ocular pain

When Is Pain After Cataract Surgery an Emergency?

Seek urgent assessment for:

• Severe or increasing eye pain
• Pain not relieved by recommended medication
• Sudden or rapidly worsening vision
• Marked redness
• Significant discharge
• Increasing light sensitivity
• Eyelid swelling with worsening vision
• Headache, nausea or vomiting
• Coloured halos accompanied by pain
• A white spot on the cornea
• New flashes
• A sudden shower of floaters
• A curtain-like shadow
• Eye trauma

These symptoms are not typical of routine uncomplicated healing.

Endophthalmitis

Endophthalmitis is a serious infection inside the eye.

Possible symptoms include:

• Increasing pain
• Rapid reduction in vision
• Marked redness
• Increasing light sensitivity
• Eyelid swelling
• Discharge

It requires urgent treatment.

Raised Eye Pressure

Eye pressure can rise after surgery because of:

• Retained viscoelastic
• Inflammation
• Steroid response
• Pre-existing glaucoma
• Retained lens material

Possible symptoms include:

• Eye ache
• Brow pain
• Headache
• Blurred vision
• Halos
• Nausea or vomiting

Some patients have no pain despite raised pressure, which is why postoperative checks remain important.

Corneal Abrasion

A scratch or epithelial defect may cause:

• Sharp pain
• Watering
• Foreign-body sensation
• Light sensitivity
• Difficulty opening the eye

Treatment depends on the size, cause and condition of the cornea.

Significant Inflammation

More inflammation than expected may cause:

• Aching
• Redness
• Light sensitivity
• Blurred vision
• Increasing discomfort

The drop regimen may need adjustment after examination.

Retained Lens Material

Residual lens material can occasionally cause:

• Inflammation
• Pain
• Raised pressure
• Corneal swelling
• Delayed visual recovery

Small soft fragments may resolve with treatment. Larger fragments may require another procedure.

Can Severe Pain Mean Retinal Detachment?

Retinal detachment usually causes:

• Flashes
• New floaters
• A curtain-like shadow
• Peripheral visual-field loss

It is often painless.

The absence of pain does not mean a retinal symptom is safe to ignore.

New flashes, many floaters or a shadow after cataract surgery require urgent retinal assessment.

How Can Anxiety Be Reduced Before Surgery?

Understand the Procedure

Knowing what will happen can reduce fear of the unknown.

Patients should understand that:

• The eye will be numbed
• Blinking will not interfere
• The surgeon can add anaesthetic
• Seeing light and colour is normal
• The procedure can be paused if necessary
• Sharp pain should be reported

Tell the Surgeon About Previous Experiences

Inform the surgeon if you previously had:

• A painful first-eye operation
• Difficulty with anaesthetic drops
• Severe claustrophobia
• Panic attacks
• Post-traumatic stress
• Problems with sedation
• Difficulty lying flat
• Chronic pain

The plan for the second eye can sometimes be adjusted.

Practise Lying Still

Patients with neck, shoulder or back discomfort may benefit from discussing:

• Pillow placement
• Head support
• Operating-table position
• Breaks before surgery
• Appropriate pain medication

Discuss Sedation

Sedation may be helpful, but more is not always better.

The aim is usually to achieve:

• Calmness
• Cooperation
• Comfortable breathing
• Stable positioning
• Appropriate awareness

Use Clear Communication

Agree before surgery on how to signal:

• Pain
• Need to cough
• Need to move
• Nausea
• Breathing difficulty
• Panic

Do not make a sudden movement without warning the surgeon.

Can You Cough or Sneeze During Surgery?

A cough or sneeze can happen.

Tell the surgeon as early as possible if you feel one coming.

The surgeon can:

• Stop manipulating the eye
• Remove or stabilise instruments
• Allow the patient to cough safely
• Resume when the patient is settled

Patients with chronic cough, reflux, asthma or difficulty lying flat should discuss this before surgery.

What if You Panic Under the Drape?

Tell the team immediately.

Do not sit up or move suddenly.

The team may:

• Reassure you
• Adjust the drape or airflow
• Pause the operation
• Give additional sedation
• Reposition you
• Convert the anaesthetic approach if necessary

Severe claustrophobia should be disclosed during preoperative assessment so that preventive arrangements can be made.

Is Laser Cataract Surgery Less Painful?

Femtosecond laser-assisted cataract surgery uses a laser for selected steps, such as:

• Capsulotomy
• Initial lens fragmentation
• Corneal incisions
• Selected astigmatic incisions

It does not eliminate:

• Local anaesthesia
• Entry into the eye
• Removal of lens fragments
• IOL implantation
• Postoperative inflammation
• The possibility of discomfort

Both conventional phacoemulsification and femtosecond-assisted surgery are generally well tolerated.

Laser assistance should not be chosen solely on the assumption that it guarantees a completely sensation-free procedure.

Is Cataract Surgery More Painful Than LASIK?

The experiences are different.

LASIK primarily involves the cornea and commonly causes:

• Pressure during suction
• Brief dimming of vision
• Early burning or watering as the anaesthetic wears off

Cataract surgery is performed inside the eye and may involve:

• Bright lights
• Fluid
• Internal pressure or movement
• Mild postoperative grittiness

Both procedures are normally performed under local anaesthetic and should not cause severe surgical pain.

An individual patient may find either procedure more uncomfortable depending on:

• Anxiety
• Anaesthetic response
• Surgical complexity
• Ocular-surface sensitivity
• Previous experience

Is Cataract Surgery More Painful Than an Eye Injection?

They are separate experiences.

An intravitreal injection commonly involves:

• Antiseptic preparation
• Eyelid speculum
• Brief pressure or pinching during injection

Cataract surgery lasts longer but uses continuing local anaesthesia and may involve sedation.

Patients who tolerated retinal injections should still discuss cataract-surgery anxiety because the visual and sensory experiences differ.

Frequently Asked Questions

Is Cataract Surgery Completely Painless?

Many patients describe it as painless.

Others notice mild pressure, stinging or brief discomfort.

Severe pain is not expected.

What Is the Most Uncomfortable Part?

This varies.

Possible moments include:

• The first anaesthetic or dilating drops
• Antiseptic preparation
• Injection of a regional block
• Insertion of the eyelid holder
• Bright microscope light
• Iris manipulation in a small pupil
• Pressure during selected surgical steps

Will I Feel the Eye Being Cut?

Most patients do not.

The cornea is numbed before the incision is made.

Will I Feel the Cataract Being Broken Up?

Usually not as pain.

You may notice pressure, fluid or machine sounds.

Will I Feel the Artificial Lens Being Inserted?

Usually not.

The folded IOL unfolds inside the capsular bag without creating a sensation that most patients can identify.

Can I Ask for More Anaesthetic?

Yes.

Tell the surgeon if you experience sharp or significant pain.

The safest approach is communication—not silent endurance.

Can I Request General Anaesthesia?

You may discuss it, but general anaesthesia is not automatically the safest or most appropriate choice.

It is generally reserved for specific clinical situations.

Will Sedation Put Me Fully to Sleep?

Usually not.

Light or moderate sedation makes the patient relaxed and drowsy while retaining the ability to respond.

Will I Remember the Operation?

Some patients remember lights and conversation clearly.

Others remember very little, especially when sedation is used.

Can I Blink During Surgery?

The eyelid speculum holds the lids open, so blinking is not a problem.

What if My Eye Moves?

Small natural eye movements can usually be managed.

Follow the surgeon’s instructions and avoid sudden head movement.

What if I Need to Cough?

Tell the surgeon before coughing whenever possible.

The operation can be paused safely.

Does a Dense Cataract Hurt More to Remove?

Not necessarily.

Dense cataracts may require more energy and manipulation, so the anaesthetic plan may be adjusted accordingly.

Is Second-Eye Surgery More Painful?

Some studies report slightly higher pain scores during second-eye surgery, but the average difference is small and many patients notice no meaningful difference.

Will My Eye Hurt After Surgery?

Mild grittiness, irritation or aching may occur.

Severe or increasing pain requires prompt review.

How Long Does Discomfort Last?

Mild irritation commonly improves over the first few days.

Dry-eye symptoms may fluctuate for several weeks or, in some patients, longer.

Can I Take Painkillers?

Use only medication that is safe for you and consistent with your surgeon’s instructions.

Contact the clinic when pain is significant or persistent rather than repeatedly increasing pain medication.

Why Does the Eye Water if It Is Dry?

Dryness and surface irritation can trigger reflex tearing.

Watery eyes do not exclude dry-eye disease.

Why Does My Eyedrop Sting?

Drops may sting because of:

• The active medication
• Preservatives
• An irritated ocular surface
• Temporary changes in tear-film quality

Severe or prolonged burning should be reported.

Is Headache Normal?

A mild headache may result from:

• Anxiety
• Bright light
• Fasting
• Positioning
• Sedation
• Eye strain

A severe headache with eye pain, blurred vision, halos, nausea or vomiting may indicate raised eye pressure and requires urgent assessment.

Is Light Sensitivity Normal?

Mild light sensitivity can occur during early healing.

Increasing or severe photophobia with redness, pain or reduced vision requires assessment.

Is It Normal for Pain to Become Worse After Two or Three Days?

No.

Normal discomfort should generally improve.

Increasing pain, redness or visual loss may indicate infection or inflammation and requires urgent review.

Can Cataract Surgery Cause Long-Term Nerve Pain?

Persistent neuropathic ocular pain is uncommon but recognised.

Symptoms such as prolonged burning, wind sensitivity or pain disproportionate to surface findings warrant specialist assessment.

Key Takeaway

Cataract surgery is not usually painful.

The eye is numbed using:

• Anaesthetic drops or gel
• Anaesthetic placed inside the eye
• Sub-Tenon’s anaesthesia
• Peribulbar or retrobulbar block
• A combination of techniques

Sedation may be added to reduce anxiety, but local anaesthesia provides the principal pain relief.

During surgery, patients may notice:

• Bright lights
• Colours
• Shadows
• Cool fluid
• Pressure
• Touching
• Movement
• Machine sounds

These sensations do not necessarily indicate pain or a problem.

Patients should tell the surgeon immediately if they feel:

• Sharp pain
• Increasing pain
• Intolerable pressure
• Panic
• Nausea
• Need to cough or move

After surgery, mild symptoms may include:

• Grittiness
• Watering
• Light sensitivity
• Mild aching
• Foreign-body sensation
• Fluctuating dryness

These should generally improve.

Seek urgent assessment for:

• Severe or increasing pain
• Pain not relieved by recommended medication
• Sudden or worsening vision
• Marked redness
• Significant discharge
• Increasing light sensitivity
• Headache with nausea or vomiting
• New flashes
• Many new floaters
• A curtain-like shadow
• Eye trauma

The objective is not necessarily to eliminate every awareness that surgery is happening. It is to provide sufficient anaesthesia so that the operation is safe, tolerable and free from significant pain.

Good preparation, appropriate anaesthetic selection and clear communication with the surgical team make cataract surgery a comfortable experience for most patients.

References

1. National Eye Institute. Cataract Surgery. Updated December 2024.
2. American Academy of Ophthalmology. Cataract Surgery: Risks, Recovery and What to Expect. Updated 2025.
3. Mayo Clinic. Cataract Surgery. Updated April 2026.
4. Singapore National Eye Centre and SingHealth. Cataract Surgery: Diagnosis, Procedure and Risks.
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