Anesthesia For Eye Surgery

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Anesthesia For Eye Surgery

Most eye surgery is performed while you are awake, yet comfortable. Occasionally a sedative is needed, but general anesthesia is often not needed.

Retina surgery is painless, you remain awake and is performed on an outpatient basis.  Advances in technology have decreased the length of surgery making outpatient eye surgery possible.

There are two basic methods of anesthesia; awake (aka local) and asleep (aka general).

Local Anesthesia with Sedation

Most of my operations, either vitrectomy or scleral buckle, are all completed in less than an hour.  Some cases can take longer, but not often.  These relatively short operating times make it possible to operate with simple local anesthesia.

“Local” means that you are awake and numbing medicine (e.g. Lidocaine) is injected around the eye to provide sufficient numbing.  This also inhibits eye movement.

Prior to the injection, to avoid the discomfort of the injection around the eye, a heavy sedative is given to make you sleepy for a few minutes.  You are completely unaware of the injection that numbs the eye.  When you awake, the eye is numb and can’t move.  You don’t remember a thing.

I prefer this method for almost all my patients.  The recovery after surgery is usually quite short as there is no need to recover from the systemic effects of general anesthesia.  You are usually able to leave in less than 30 minutes after surgery.

Requirements for having local anesthesia with sedation; your doctor must clear you medically for surgery, you can lie still and you are not claustrophic (there is a surgical drape place over you during the operation).

(By the way, most adult eye surgery, including cataracts are performed in similar fashion.  There are a few centers, that use only topical numbing medication for the cataract surgery.  This is not recommended for retinal surgery.)

General Anesthesia

General anesthesia is rarely needed for my patients.  The recovery period is usually longer and more complicated as it takes a long time for the body to metabolize the drugs used to keep you asleep.  Nausea is more common than with local anesthesia.

There are times, however, when this is preferable.  In young children, patients with dementia, patients with high anxiety, etc., it is safer to use general anesthesia.  Sudden movements of the head can ruin surgery and cause permanent damage.

I also like to place patients under general anesthesia with patients that talk too much.  Though this usually reflects a level of anxiety, talking causes the head to move, and thus the eye.  It makes it more difficult, and more dangerous, to operate.

Compromise

Many patients fear being awake during surgery.  Rest assured, if you can not tolerate being fully awake, we can also give you some sedation through the intravenous during the operation.  If needed, we can always “convert” to general anesthesia.

What Does This Mean? There are a variety of ways to provide safe and effective anesthesia for retina surgery.  The goal is to provide safe, yet effective means to complete the surgery.

By safe, I mean two things.  I don’t want to jeopardize your eye, and second, we don’t want to jeopardize your health.  We try to avoid general anesthesia, but balance your eye safety to make that decision.

Regardless, you should not be afraid of your eye surgery.  While many fear the whole process, there are several ways to keep you comfortable, safe…and calm.

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Comments
  • Jane Burton October 29, 2011 at 10:02 pm

    Thank you so much for your clear and helpful info about anesthesia during eye surgery. So many sites make you pay for info or watch commercials. How kind of you to provide this help.

    Jane Burton, St. Louis MO

    • Randall V. Wong, M.D. November 5, 2011 at 10:35 am

      Dear Jane,

      Thanks for the comments! Appreciate it. Glad it was helpful.

      r

  • tom higgins August 30, 2012 at 5:03 am

    hi randall. i live in ireland and have been diabetic for 8 years this coming xmas. last year i had my annual eye test and it was discovered that i had a sall bleed in one eye which was not in the central vision. so i feel no difference in my sight. i inject humalog mix 25 twice daily for my diabetes. my hb aic is 6.5. i wonder if the bleed will clear up itself and i am having my annual eye test next tuesday the 4 of september. so all will be revealed then. what im trying to say really is that once a bleed happens , is that it? does it just get worse or how does it work. i know sugar levels are important. but i suppose people worry more when its their eye. i appreciate all your info. nice to know i could be knocked out for an operation. during an op, if only one eye is treated at a time, would i be able to see whats happening from my other eye? anyway, maybe im worrying too much at this stage as my doctor said it takes years for it to take hold. i wonder how long does it actually take to take hold.. yours in all sincerity. i am just turning 59 years of age. cheers tom

    • Randall V. Wong, M.D. September 3, 2012 at 9:01 am

      Dear Tom,

      There are two types of bleeding with diabetic retinopathy.

      1. Intraretinal hemorrhage, or bleeding within the retinal tissue, is very common and seen in almost every diabetic patient with retinopathy. These are commonly seen in “non-proliferative” diabetic retinopathy and do not need treatment per se. These may go away with time, but others will appear and is a lifelong process, but need to pay attention only to macular edema associated with these findings, that is, the “bleeding” itself poses little threat to you.

      2. Vitreous hemorrhage is bleeding within the vitreous cavity and stems from the presence of neovascularization. This is indicative of “proliferative” diabetic retinopathy and can eventually lead to blindness. The blood may absorb, but the neovascularization will persist until treated.

      Which case is yours?

      Randy

    • Randall V. Wong, M.D. September 3, 2012 at 9:01 am

      Dear Tom,

      There are two types of bleeding with diabetic retinopathy.

      1. Intraretinal hemorrhage, or bleeding within the retinal tissue, is very common and seen in almost every diabetic patient with retinopathy. These are commonly seen in “non-proliferative” diabetic retinopathy and do not need treatment per se. These may go away with time, but others will appear and is a lifelong process, but need to pay attention only to macular edema associated with these findings, that is, the “bleeding” itself poses little threat to you.

      2. Vitreous hemorrhage is bleeding within the vitreous cavity and stems from the presence of neovascularization. This is indicative of “proliferative” diabetic retinopathy and can eventually lead to blindness. The blood may absorb, but the neovascularization will persist until treated.

      Which case is yours?

      Randy

  • Vinaah April 8, 2013 at 12:09 am

    Hi Dr,

    I am from Melbourne and I am having my surgery on Thursday @ Royal Victorian Eye and Ear Hospital. I am freaking out just with the thought of getting needles for the anesthesia. They have advised that they will give me sedative and then local to numb it. I have a serious fear of needles, ironic that I am an insulin dependent diabetic.

    Nevertheless your comment:
    Prior to the injection, to avoid the discomfort of the injection around the eye, a heavy sedative is given to make you sleepy for a few minutes. You are completely unaware of the injection that numbs the eye. When you awake, the eye is numb and can’t move. You don’t remember a thing.
    has made me feel much better, knowing that when i will fall asleep during the injection to numb my eye.

    I really hope that the above is exactly what the surgeon will be doing for me on Thursday.

    I have to now get over the sedative injection section.

    Still a bit troubled and nervous.

    Vinaah

  • Chrissie February 1, 2019 at 1:04 pm

    Hello Dr.,

    I had surgery to reattach my retina 6 weeks ago. Silicone oil was used. I will have the oil removed from my eye in a few weeks time. I will also have a cataract removed at this time, which has formed since the operation. My surgeon says that it will be done under general anaesthetic. I’m not happy about this, as I already had to have the retina reattached under general and from reading all available literature, it seems these procedures are normally done under local anaesthetic. I have small children and a 6 week old baby and do not want to have an unnecessary general anaesthetic. I’m going to raise the matter further with him, but it seems to be what he does: all his surgeries seem to be done under general. Does this seem normal? Will having the procedures done under local be too much for me? Is it really awful to have those procedures done while awake? Your advice would be greatly appreciated!

    • Randall Wong, M.D. February 28, 2019 at 3:02 am

      Chrissie,

      Sorry for the delay, but I hope your surgery went well. Anesthesia choice does vary from surgeon to surgeon. r

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