Cataract surgery is a common and generally safe procedure to remove clouded lenses from the eyes and replace them with clear artificial lenses. Part of the standard preparation for cataract surgery is to use medicated eye drops before the operation. Understanding why these eye drops are necessary and what they do can help you follow instructions from your ophthalmologist and get the best results from your cataract surgery.
What are the eye drops used before cataract surgery?
There are usually three main types of medicated eye drops that are prescribed to use in the days and weeks leading up to cataract surgery:
- Antibiotic eye drops
- Anti-inflammatory eye drops
- Pupil-dilating eye drops
Each type of eye drop has a specific purpose in preparing the eye for surgery.
Antibiotic Eye Drops
Antibiotic eye drops are used to prevent infection before and after the operation. Common options include drops containing fluoroquinolones, aminoglycosides, or a combination of antibiotics. Examples of specific antibiotic eye drops prescribed before cataract surgery include:
- Gatifloxacin 0.3%
- Moxifloxacin 0.5%
- Gentamicin 0.3%
- Tobramycin 0.3%
- Polytrim (polymyxin B sulfate/trimethoprim)
Your ophthalmologist will direct you when to start using the antibiotic drops before surgery. This helps lower the risk of bacteria entering the eye during surgery and causing an infection in the cornea or other structures.
Anti-inflammatory Eye Drops
Anti-inflammatory eye drops, also called steroid eye drops, are commonly prescribed for use 1-2 weeks prior to cataract surgery. They help control inflammation and prevent fluid buildup in the eye after the operation. Examples of anti-inflammatory drops given before cataract surgery include:
- Prednisolone acetate 1%
- Dexamethasone 0.1%
- Loteprednol etabonate 0.5%
- Rimexolone 1%
Starting these drops ahead of the surgery jumpstarts the anti-inflammatory action in the eye. Controlling swelling and inflammation is crucial for quick recovery and to reduce risks like macular edema after the procedure.
Pupil-Dilating Eye Drops
Pupil-dilating, or mydriatic, eye drops enlarge the pupil and allow the ophthalmic surgeon to better view the lens during cataract surgery. Common options prescribed before surgery include:
- Tropicamide 1%
- Cyclopentolate 1%
- Phenylephrine 2.5%
- Atropine 1%
These dilating drops are usually given on the day of the procedure at specific time intervals (such as every 15 minutes for 1 hour). The enlarged pupil size persists during the operation so the surgeon can clearly see the lens and surrounding structures through the dilated opening.
Why are pre-op eye drops so important before cataract surgery?
Using eye drops as directed leading up to cataract surgery is extremely important for several reasons:
1. Prevent Infection
Antibiotic eye drops prior to the cataract procedure minimizes the risk of developing infectious endophthalmitis. This is a serious complication where bacteria enters the eye during or after surgery leading to severe inflammation and vision loss. The antibiotic drops sterilize the ocular surface and eyelids to keep bacteria away from the surgical site.
2. Control Inflammation
Inflammation after surgery commonly occurs and can interfere with proper healing. Steroid eye drops before and after the procedure counteract swelling, irritation, and fluid buildup inside the eye that leads to cystoid macular edema. This complication damages the macula and central vision. The anti-inflammatory action of drops helps prevent it.
3. Dilate the Pupil
Pupil dilation is mandatory for cataract removal and artificial lens implantation. Eye drops enlarge the pupil so the surgeon can properly visualize the lens and utilize microsurgical techniques through a widely dilated pupil. This allows complete removal of cataract fragments and optimal positioning of the intraocular lens implant.
4. Follow Your Surgeon’s Recommendations
Closely follow your ophthalmologist’s instructions for using medicated eye drops before cataract surgery. This protocol is customized for your eyes and health profile to support the best surgical experience and visual outcome with minimal risks of complications. Do not skip or delay using any drops as prescribed.
What is the typical schedule for eye drops before cataract surgery?
The standard protocol includes:
- Antibiotic eye drops – Start using them about 3-5 days before surgery as directed. Continue using them on the day of your procedure.
- Anti-inflammatory eye drops – Begin using 1-2 weeks before the scheduled surgery date. Use them on the day of the procedure as well.
- Pupil dilation eye drops – Administer these drops on the day of your surgery, usually every 15 minutes for 1 hour prior to the operation.
However, always follow the specific instructions from your ophthalmologist, as the schedule for your drops may be adjusted based on your individual health factors. Be sure you understand when to use each medication leading up to your cataract operation.
What are some common questions about using eye drops before cataract surgery?
Are eye drops required before cataract surgery?
Yes, eye drops are a mandatory part of preparation for cataract removal in most cases. They optimize the ocular surface and environment to support surgical safety and success.
Can I be allergic to the eye drops?
Allergies to eye drops are possible but relatively uncommon. Let your ophthalmologist know if you have any known medication allergies. Signs of a reaction can include redness, severe itching, rash, and swelling.
What if I miss a dose of the pre-op eye drops?
Use the drops as soon as you remember if it is close to the scheduled time. But do not double up doses to try to catch up if more than an hour has passed. Call your surgeon’s office if you miss multiple doses to discuss if any changes are needed to the protocol.
How do I properly use each eye drop?
Follow these steps for each dose of eye drops before cataract surgery:
- Wash your hands thoroughly.
- Gently pull your lower eyelid down and tilt your head back.
- Position the dropper above your eye without touching it.
- Squeeze the bottle to release one drop inside the lower eyelid pocket.
- Close your eye gently for 1-2 minutes.
- Apply gentle pressure on the tear duct to prevent the medication from draining away too fast.
- Repeat steps as needed for the other eye if both are being operated on.
Should I stop my regular eye medications before surgery?
Never stop medications like glaucoma eye drops unless specifically instructed to do so by your surgeon. But do let the ophthalmologist know all medications you currently use so your perioperative eye drop regimen can be optimized.
Conclusion
Starting a regimen of antibiotic, anti-inflammatory, and pupil dilating eye drops leading up to planned cataract surgery is a vital component of preoperative care. Closely follow the schedule provided by your ophthalmologist and properly use each eye drop as directed. This protocol before the procedure minimizes surgical risks and promotes optimal results so you can get the best vision outcome possible.
