Cataract Surgery Complications, Risks and Side Effects

Last Updated: August 20, 2024

Sources

How Safe is Cataract Surgery?
For most patients, cataract surgery will cause no complications. Cataract surgery is a proven low-risk procedure with a success rate of approximately 99 percent. Mild side effects are likely and will usually go away on their own, requiring little or no treatment.
Table of Contents
Side Effects
Common Complications
Rare Complications
Cataract Surgery Risks
Complications in Elderly Patients
FAQs

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The advancements made over the years including foldable intraocular lenses, use of topical anesthetics, and the introduction of phacoemulsification has allowed for the modern extraction of cataracts to be more effective and safer than ever.¹However, as with any surgery, complications are possible, although very rare.

Phacoemulsification

Cataract surgery involves removing the cloudy lens and replacing it with a new, clear, artificial lens. This artificial lens is called an intraocular lens implant (IOL). During traditional cataract surgery, the lens is manually removed by the surgeon through a 10mm incision. Laser-assisted phacoemulsification is a more modern approach that allows surgeons to decrease the incision in the eye from 10mm to typically less than 3mm, which has the benefits of shorter recovery times, more stable surgery, and a lower complication rate.¹

During phacoemulsification, the lens capsule (an elastic membrane surrounding the lens of the eye) is left in the eye during surgery. Only the inner core and the outer cortex of the lens are broken up into small pieces using ultrasound. The pieces are then sucked out of the eye through a small cut. Once the lens has been removed, the IOL is implanted into the lens capsule.

Cataract Surgery Temporary Postoperative Side Effects

While cataract surgery is a low-risk procedure, some side effects are to be expected. The following mild side effects are normal and typically fade within the first couple weeks (with the exception of dry eye, which can last longer). If any of these symptoms do not fade away soon after the cataract surgery, worsen, and/or become problematic for you, contact your eye surgeon’s office. If your symptoms are caused by rarer complications, prompt intervention is crucial to ensure the best vision and health outcomes.

Red Eye

Redness in the eye after cataract surgery is quite common and usually not a cause for concern. This redness can result from minor inflammation or from a small blood vessel breaking (known as a subconjunctival hemorrhage), leading to a bright red spot. These symptoms typically improve within a few days to weeks as the eye heals.

Dry Eye

Dry eye is a very common complication after cataract surgery, affecting up to 92% of patients in the first week. The symptoms are usually mild but can last for 1-3 months. Cataract surgery can disrupt the tear film that covers the eye, leading to dry eye.In most cases, dry eye symptoms resolve within 1-3 months without treatment. Artificial tears are the main treatment to add moisture to the eyes.

Light Sensitivity

Some light sensitivity (photophobia) is normal after cataract surgery, but ongoing or severe light sensitivity can be indicative of eye swelling or inflammation. If a patient is experiencing light sensitivity longer than a few days after surgery, they should seek medical care.

Dizziness

Most dizziness experienced after cataract surgery is temporary and should improve as the eye heals and the brain adjusts to the new lens. Patients typically notice a reduction in dizzy spells within a few weeks post-surgery. .

For the first few hours after cataract surgery, you may experience dizziness due to the anesthetic eye drops or because your eye is still in the early stages of recovery. If dizziness persists or remains frequent for days or weeks after the operation, this still may suggest your eye and brain are adjusting to your new vision. You were accustomed to how the cataract refracted light into your eye, so you may need time to adjust to the power of the new artificial lens.

In rare instances, dizziness can indicate damage to part of your eye caused by the surgery or another underlying problem. Report this symptom to your eye doctor or your general practitioner, especially if there are other associated symptoms like nausea.

Floaters

Floaters are spots in your vision that can drift around in your eyes and cause annoyance. They develop in the vitreous fluid of your eye, and they are also common in people who have had cataract surgery. Typically, floaters are not caused by cataract surgery directly. Instead, the replacement of the cloudy lens with a clear one just makes the floaters more apparent.

When a cataract matures, its size grows and swells in comparison to a normal lens. A clear replacement intraocular lens is much more compact than the cloudy swollen lens. As a result of the smaller thickness, the vitreous gel behind the clear intraocular lens also has a little bit more room to move which can make the vitreous floaters appear more noticeable.

If floaters appear after cataract surgery, talk to your eye doctor. These floaters can be a sign of a retinal tear that will need to be treated. If the exam shows no tears or holes in your retina, the floaters can be left alone. Often, they will decrease or disappear from your sight as they move out of your field of vision or the brain adapts to their presence

Headache

Discomfort and pain in and around the eye can feel like a headache. This can usually be managed with over-the-counter analgesic medications and/or anti-inflammatory eyedrops. Headaches after cataract surgery are not common, but it is possible to experience discomfort and eye pain. This often resolves soon after the surgery.

Droopy Eyelids

Droopy eyes (called ptosis) are common after surgery and usually disappear within a few weeks, if not sooner. If ptosis persists and affects vision, it may need to be treated with surgery (blepharoplasty).

Eye Inflammation and Swelling of the Cornea

Mild swelling is normal immediately after surgery, but swelling that is severe or lasts for more than a few days after surgery may need additional treatment, such as anti-inflammatory medications or eyedrops.

Increased Pressure Inside the Eyeball (Ocular Hypertension)

Eye surgery, including cataract surgery, can increase pressure in the eye. This can affect vision and eye health, and it can even cause glaucoma. Ocular hypertension is usually treated with medications or eye injections. Ocular hypertension after cataract surgery is relatively common but usually transient, with many patients returning to normal IOP levels within a day. However, close monitoring is crucial, particularly for those at higher risk, to prevent potential complications associated with elevated intraocular pressure, like glaucoma or corneal edema.

Complications of Cataract Surgery

The most common complication of cataract surgery is Posterior Capsular Opacity (PCO), which can make vision appear foggy.

During cataract surgery, the cloudy natural lens of the eye is removed and replaced with an IOL plastic artificial lens, called an intraocular lens (IOL). Part of the lens tissue, the capsule, is left in place during and after surgery to help keep the artificial lens IOL in place.

This part of the capsule can become foggy and cause vision problems, leading to PCO. This is sometimes also called secondary cataracts or after-cataracts. However, PCO is not actually a cataract. In fact, this issue is affecting a different part of the eye than the part that was treated during the surgery. Cataracts cannot develop on the artificial lens.

Posterior Capsular Opacity

Posterior capsular opacity (PCO) occurs in approximately 20 percent of people who had cataract surgery. A PCO can develop any time, from weeks to even years after the cataract surgery. It can result in blurred vision if left untreated.

A PCO is treated with YAG laser capsulotomy. This is a quick and painless outpatient procedure. It literally takes only 5-10 minutes for this procedure. It’s unlikely that once you have a YAG laser capsulotomy that another PCO will return. It’s rare that a patient will need a second capsulotomy procedure in the same eye during the patient’s lifetime.

Rare Complications of Cataract Surgery

While serious complications after cataract surgery are rare, they can have significant implications for vision and eye health. Awareness of these potential issues can help patients recognize symptoms early and seek prompt medical attention. Regular follow-up with an ophthalmologist is essential for monitoring recovery and addressing any complications that may arise.

Intraocular Lens Dislocation

IOL dislocation occurs when the IOL that was implanted during cataract surgery becomes dislodged from the “capsular bag” in which it was placed. This can cause a patient to experience blurry vision or double vision. Intraocular lens dislocation after cataract surgery is extremely rare, occurring in less than 3% of patients. It’s usually treated with surgery that replaces the lens or moves it back into place.

Ineffective Surgery

In rare cases, cataract surgery may not improve vision. This scenario becomes more likely for patients experiencing multiple eye conditions. Cataract surgery may still be performed in the hopes that vision may be improved despite the presence of another eye disease. Sometimes vision is not expected to improve with cataract surgery, but the eye doctor needs to remove the cataract to see the back of the eye more clearly. Usually, the doctor will discuss with the patient that vision may not improve after cataract surgery if there is another cause for the vision loss.

Examples of eye conditions that can limit vision outcomes after cataract surgery are macular degeneration, retinopathy and glaucoma.

There are also relatively rare instances in which there is a complication during or after the surgery resulting in unexpected vision loss. Patients should be aware that even though most cataract surgeries result in excellent postoperative vision, there is always a minor but real risk of complications resulting in vision loss. It is sometimes difficult to know whether a side effect is severe enough to warrant attention, so it’s important to always discuss side effects with your eye doctor.

Detached Retina

Retinal detachment (RD) is a serious but relatively rare complication that can occur after cataract surgery. About 1% of patients will experience retinal detachment. It can occur months, and even years, after cataract surgery. This happens when the sensitive tissue at the back of the eyes (the retina) moves from its normal position. This separates the cells in the retina from the layer of blood vessels that supply oxygen and nutrients to the eye. The longer the retina is detached, the greater the risk of significant, and perhaps permanent, vision loss.

Patients should be vigilant for the following symptoms, which may indicate retinal detachment:

Sudden onset of floaters: Increased floaters in the field of vision.
Flashes of light: Perception of light flashes in the peripheral vision.
Darkening of vision: A shadow or curtain effect over part of the visual field.
Blurry vision: Sudden blurriness or loss of vision.

If any of these symptoms occur, it is crucial to seek immediate medical attention, as timely intervention can prevent permanent vision loss. In 9 out of 10 times,surgeons can completely restore vision if the detachment is promptly diagnosed and treated.

Excessive Bleeding

Mild bleeding immediately after surgery isn’t abnormal and may be a common side effect. However, more serious or ongoing bleeding is indicative of a serious medical emergency. The bleeding may be a result of leaking blood vessels. Immediate care is needed to prevent vision loss.

Endophthalmitis

Endophthalmitis is an infection of the tissues or fluids inside the eye that can (although rarely) occur after cataract surgery. The most common symptoms of endophthalmitis are²:

Eye pain that keeps getting worse after surgery
Red eye
White or yellow pus or discharge from the eye
Swollen or puffy eyelids
Decreased, blurred or lost vision

Endophthalmitis is considered a medical emergency. If you have symptoms, see an eye doctor as soon as possible. Endophthalmitis can blind you if it’s not treated quickly.

You deserve clear vision. We can help.

The board-certified surgeons at NVISION have performed over 2.5 million procedures. Your journey to better vision starts here.

Book a Consultation Now or Find a Location

Cataract Surgery Complications in Elderly Patients

Cataract surgery is safe and works well for most people who need it. For very elderly patients (people over 85), there are higher risks of complications during surgery. Older patients are more likely to have pre-existing eye conditions that can affect how well the surgery works (like age-related macular degeneration). Older patients with heart conditions are also at higher risk of systemic complications during cataract surgery.

However, age alone should not prevent you from getting cataract surgery. The procedure is regularly done with great success on patients in their 80s and 90s. There is no age limit for cataract surgery. If you have preexisting conditions, your eye surgeon should be made aware to ensure proper pre-op assessment, surgical planning, and postoperative care.

Cataract Surgery Risks

The presence of underlying health issues or other eye problems mentioned above may increase the risk of serious complications after cataract surgery. In general, any condition that affects the structure or health of the eye or body may potentially increase the risk of complications after cataract surgery. It’s best to discuss pre-existing conditions with your health care provider before undergoing surgery.

Common risk factors associated with complications after cataract surgery are:

Diabetes
High blood pressure
Autoimmune disorders
Previous eye injuries or surgeries
Chronic use of steroid medications
Previous retinal detachment
Macular degeneration
Glaucoma
Corneal diseases

Cataract Surgery Complications FAQ

Does Laser Eye Surgery Increase the Risk of Cataracts?

Laser vision correction procedures do not cause cataracts.⁷ It is possible that if there was a complication during the laser procedure, then this complication may influence the development of a cataract. For example, if there was significant inflammation after LASIK and the patient was on steroid eye drops for a long period of time, long term steroid use may accelerate cataract development.⁸

How Long is the Risk of Infection After Cataract Surgery?

Although most cases of postoperative endophthalmitis occur within 6 weeks of surgery, infections seen in high-risk patients or infections caused by slow-growing organisms may occur months or years after the procedure.⁹Typically, postoperative endophthalmitis is caused by the introduction of microbial organisms into the eye. Once organisms gain access inside the eye, inflammation is likely to occur, making rapid recognition, diagnosis, and treatment critical in optimizing final outcomes.

References

Houser, K. History of Cataract Surgery. EyeWiki. History of Cataract Surgery – EyeWiki (aao.org). Accessed August 7, 2024.
Mukamal, R. What is Endophthalmitis? (2023 Nov 27). Retrieved from What is Endophthalmitis? – American Academy of Ophthalmology (aao.org).
When is the Right Time to Have Cataract Surgery? 02 Jun 2015. Retrieved from https://www.aao.org/newsroom/news-releases/detail/when-is-right-time-to-have-cataract-surgery
Is Cataract Surgery Safe for Patients Above 65 of Age? 2014 Feb 21. Retrieved from https://www.aao.org/eye-health/ask-ophthalmologist-q/cataract-surgery-seniors
Nall, R. Can Corticosteroids Affect Vision? https://www.healthline.com/health/steroids-and-vision. Accessed August 8/2024.
Cataract Surgery Complication Rates. (August 2008). Ophthalmology.
Pandya, HK. Postoperative Endophthalmitis. 16 Oct 2023. https://emedicine.medscape.com/article/1201260-overview?form=fpf
Posterior Capsule Opacification. (March 2015). Kellogg Eye Center.
Intraocular Lens Dislocation. (2016). American Society of Retina Specialists.
The Risks and Benefits of Cataract Surgery. (October 2002). Digital Journal of Ophthalmology.
Extreme Photophobia After Cataract Surgery. (March 2014). American Academy of Ophthalmologists.
Cataract and Diabetic Retinopathy. (September 2011). Community Eye Health.
Possible Side Effects and Complications after Cataract Surgery. (2021). AARP.
What Are the Risks of Cataract Surgery? VisionAware.org.
Posterior Capsule Opacification. University of Michigan Health System.
Retinal Detachment. (December 2022). StatPearls.

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