How I Practice My Opinion Surgery

When to Call After Your Retinal Surgery

When to call your doctor after retinal surgery.  Randall Wong, MD.  I want my patients to call me after retinal eye surgery if they develop pain and/or  loss of vision.  These two symptoms can be signs of either infection or retinal detachment, the two most dreaded complications of retinal surgery .

Eye Infection Can Blind

The most concerning post-operative complication of retinal eye surgery would be infection inside the eye.  Infection inside the eye, called endophthalmitis, often leads to blindness.

The most frequent symptoms of endophthalmitis are pain and loss of vision.  (Unfortunately, these symptoms are not 100% so please call your own doctor if you are concerned.)

I tell my patients to call if they develop pain that is not relieved by Tylenol, Advil or whatever usually works for headache.  Incidentally, I rarely need to give an prescription pain relief for any of my surgeries.  An advantage of this is the ability to monitor pain.

Pain can develop for other reasons other than infection, say increased eye pressure, but potentially blinding eye infection is obviously the most concerning.

Fortunately, endophthalmitis is very, very uncommon in retinal surgery.

Signs of Retinal Detachment

Signs of retinal detachment following retinal surgery are not as obvious as compared to naturally occurring retinal detachments (I couldn’t think of a better term.)  The usual signs of retinal detachment are flashes, floaters and loss of peripheral vision.

After retinal surgery, vision is usually poor so that the normal signs may be missed.

My advice for may patients is that they call if the vision gets worse, in any way, compared to the first day when the patch comes off.

Compared to cataract surgery, retinal surgery usually does not restore the vision quickly, if at all.  I ask my patients to distinguish between actual worsening vision versus vision which fails to improve as quickly as hoped.

In general, if the vision improves or stays the same after the patch is removed…things are fine.

What Does This Mean?

These are my own recommendations for my patients.  While I feel these are very good guidelines and have worked well for my patients over the past 20+ years, please follow the directions and recommendations of your personal doctor.

I try to practice medicine as practically as possible.  My biggest fears following retinal surgery are infection and retinal detachment.  Your doctor may have other concerns or you may have a specific condition or situation where these recommendations don’t apply.


Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia

How I Practice

Your Retina Feels No Pain

Retinal disease is painless.  Diabetic retinopathy doesn’t hurt and neither does macular degeneration.  For that matter, a retinal detachment is nothing.  What does cause eye pain?  It can be sinus disease.

There are only a handful of problems that cause eye pain.  Neither diabetic retinopathy nor macular degeneration causes eye pain, not even a feeling.

Corneal abrasions, like skinning your knee, causes is lot of pain and sensitivity to light.  The cornea is a has a lot of nerve endings.  Scraping across the superficial layer of the cornea exposes a lot of these nerve endings causing severe pain.  It may be one of the more painful conditions you can experience. There should be obvious redness of the eye.

Nerve endings in the cornea are important.  How else could you tell if you are poking yourself in the eye?

Certain types of glaucoma can cause pain, but only the ones that cause really high eye pressure.  Most types of glaucoma don’t hurt and are painless.

Normal pressure is somewhere between 18 and 21 mmHG, but severe pain usually doesn’t happen until the pressure is greater that 40 mmHG.  The only way you’d know your eye pressure is too high is to have your eye doctor test it.  Many times redness is associated with this type of pain.

While proliferative diabetic retinopathy can cause neovascular glaucoma, leading to extremely high pressure and pain, the retinopathy itself is painless.

Iritis, also know as uveitis, is a type of inflammation that occurs inside the eye.  It is not unlike a painful arthritic joint, but only it’s the eye.  The ciliary body, a very sensitive tissue inside the eye, can become very painful with certain type of intraocular inflammation.  Eye redness is common.

Sinus Disease causes many cases of eye pain.  Really.  The nerve fibers that transmit pain from the sinuses and the eye actually course together as they wind their way to the brain to alert you of discomfort.  Because the pain fibers run so close, it is sometimes difficult to distinguish “eye pain” from “sinus pain.”

Many times I am able to distinguish between the two by a very simple observation.  In my opinion, if the eyeball itself is not red, “eye pain” is probably not coming from the eye.

Please remember, this article represents my opinion and does not, in any way, substitute for medical advice.  If you are experiencing eye pain, please inform your doctor.

What Does This Mean? It’s pretty straightforward; the retina has NO nerve endings, thus, retinal disease, including diabetic retinopathy and macular degeneration don’t hurt because…it can’t.  You can’t even feel a retinal tear or retinal detachment.

Many times patients relate loss of vision to pain or a certain “feeling.”


Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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