Eye Surgery Instructions

Many patients worry if eye surgery will be painful. Modern anesthesia has advanced greatly, helping patients feel comfortable during the procedure. There are several options for anesthesia during eye surgery and we will review them here. Many patients choose to have light sedation which is administered by an anesthesiologist or nurse anesthetist during the procedure.

Topical Anesthesia:

We use eye drops called proparacaine and tetracaine to numb the eye prior to surgery. Once the eye is numb, you may feel mild pressure and cold water during the surgery but not pain. It is normal to see bright lights during surgery as well.

Local Anesthesia:

In addition to topical anesthesia, your surgeon may recommend numbing the eye with an injection around the eye. This is called a peribulbar or retrobulbar block and it can help place the eye in a deeper state of numbing. This type of anesthesia is typically offered for cornea transplants or for surgeries anticipated to be longer or more challenging in nature.

Intravenous (IV) Anesthesia:

Though many patients prefer it, IV sedation is not necessary for eye surgery. Sedating medications, such as Versed and Fentanyl, can be given to help relax you during your surgery. Sedation is also often used when administering a local block to the eye. All medications are dosed incrementally to achieve the right level of sedation and comfort for each patient. Please be aware that even with IV sedation, MANY PATIENTS WILL BE AWAKE DURING SURGERY. Do not expect to be “put to sleep” as your eye surgeon often prefers that you can hold still and focus on the microscope light during the procedure.

General Anesthesia:

General anesthesia is when the patient is asleep for the surgery and requires that a breathing tube is placed. The majority of eye surgery cases do not require general anesthesia, however it is helpful in cases when the patient is unable to follow instructions (such as dementia) or in cases anticipated to be long or complex (such as penetrating keratoplasty – PKP).

Risks of Anesthesia:

There are risks associated with anesthesia and sedation. Though uncommon these risks include injury to the eye or surrounding structures, heart problems, and lung problems, brain injury, and in very rare cases, death.

WHAT ARE BLOOD-THINNERS?

Blood-thinning medications or anticoagulants are powerful tools to prevent complications of life-threatening blood clots and have proven benefits in preventing heart attacks and strokes. They are prescribed to prevent these blood clots from forming in people who are at risk. The benefits of these drugs must always be weighed against the risks of bleeding, particularly in patients undergoing elective surgical procedures. One of the side-effects of anticoagulants is an increase in bleeding.

Patients who take blood thinners can present challenges when surgery is needed. Common blood thinners include: Aspirin, Plavix (clopidogrel), Aggrenox, Pradaxa (dabigatran), Coumadin (warfarin), Xarelto (rivaroxaban), and Eliquis (apixaban). There are other medications that can also act as blood thinners such as ibuprofen and vitamin E. The list below is not intended to be all inclusive. Please review your medications with your primary care doctor, especially if you have questions about which medicines may be blood thinners.

CHALLENGES WITH BLOOD THINNERS IN SURGERY

Bleeding is a potential complication of any surgical procedure. People who take blood-thinning medicine around the time of their procedure are more likely to have bleeding complications during and after surgery. For operations in and around the eye, this bleeding may, in rare cases, cause loss of vision or blindness.

If you stop taking your blood-thinner(s) before surgery to lessen the chance of bleeding, you may be at greater risk of developing a life-threatening blood clot, which can cause very serious conditions such as heart attack, stroke, pulmonary embolism, and deep vein thrombosis. If, on the other hand, you continue your anticoagulants you may be at increased risk of bleeding complications. If you are on blood-thinners and need to have surgery, you must be willing to accept the potential for increased risk of one of these complications—blood clot or bleeding.

Your surgeon and your primary doctor/cardiologist will weigh the relative risks and benefits of stopping or continuing your medications before surgery and counsel you accordingly. On rare occasion, this may mean that elective surgery will be postponed or cancelled. There is always a chance that you may develop a complication related to how your blood thinners are managed around the time of your surgery. Your doctors will help you understand the relative risks involved so you can make an informed decision about how to proceed.

In summary, a patient on blood-thinners who stops these medicines before surgery may have increased risk of a heart attack, stroke or other life-threatening blood clot. A patient who continues using blood-thinners may have increased risk of bleeding complications that in rare cases may result in vision loss or blindness. It is very important to discuss your blood thinner medication with your eye surgeon and your prescribing doctor. If you note ANY abnormal symptoms after stopping your blood thinner, please call your prescribing doctor or go to the nearest emergency department as soon as possible.

MEDICATIONS AND SUPPLEMENTS THAT ARE BLOOD THINNERS

If you have a clotting disorder, heart disease, or history of stroke please talk to your primary care doctor or the prescribing doctor before stopping any medications. If you are unsure, please contact your prescribing physician or primary care doctor for instructions on handling your blood thinner medications around the time of eye surgery.

PLEASE REVIEW THIS LIST OF BLOOD THINNERS:

Advil, Alka-selzer, Anacin, APC, Ascodeen-30, Aspirin, baby Aspirin, BC powders, Bextra, Buff-a-comp, Buffadyne, Bufferin, Butalbia, Cama-Inlay, Celebrex, Ceracol, Clinoril, Congespirin, Cope, Coricidin, Dolobid, Darvon, Dristan, Duragesic, Ecotrin, Empirin, Equagesic, Excedrin, Feldene, Fionrinal, Gingko biloba, Indocin, Measurin, Meciomen, Midol, Monacet and Codeine, Motrin, Nalfon, Norgesic, Nuprin, Omega3 Fish oil, Omega-6 oil (hydroeye), Orudis, Percodan, Pabirin, Persantine, Persistine, Ponstel, Robaxisal, Sine off, SK-65, St. Johns Wart, Stendin, Stero-Darvon, Supac, Synalgos D.C., Tolectin, Triaminicin, Vitamin E, Voltaren, Zomac.

Please STOP taking any of these medications or supplements 10 days prior to your eye surgery, unless they are prescribed by your physician. If they are prescribed by your physician, then please contact the prescribing doctor to discuss further. 

If you need something for pain or headaches or menstrual cramps or other aches or pains please take acetaminophen (Tylenol) as directed.  As always, if you have questions or concerns, please call Tailored Eyes at 941-499-1570.

If you wear contact lenses, you must leave them out of your eyes for a period of time before your eye exam and measurements. This is done because the contact lens rests on the cornea and distorts its shape. This distortion can affect the accuracy of the eye measurements used to calculate the power of your lens implant. When you stop wearing your contact lenses, the cornea can return to its natural shape.

• If you wear SOFT contact lenses, STOP WEARING them at least 1 week before your refractive surgery screening visit or cataract refractive surgery measurement appointment.
• If you wear HARD (Hybrid, Rigid, or Scleral) contact lenses, STOP WEARING them at least 3 weeks before your refractive surgery screening visit or cataract refractive surgery measurement appointment.

Your surgery will be done in an outpatient surgery center or hospital and you will likely go home the same day. Continue all your usual eye drops as prescribed, including the morning of surgery. You may take your usual blood pressure or heart medications with a small sip of water in the morning unless directed otherwise by your doctor or anesthesia team. One business day prior to your surgery someone will call you from the surgery center to discuss your arrival time for surgery. Plan to be at the surgery center for several hours.

Surgery requires FASTING. NO EATING OR DRINKING starting at MIDNIGHT the night before surgery. If your surgery is scheduled for the afternoon, then please NO EATING OR DRINKING AT LEAST 6 HOURS BEFORE your arrival time.

Please wear loose comfortable clothing. Shower and wash your hair the evening prior or morning of your surgery. WASH YOUR FACE THOROUGHLY.  No Makeup, Perfume, Lotions, or Jewelry/Valuables. No Smoking or Alcohol 24 hours prior to surgery.

You will need to arrange transportation to and from the surgery. You may NOT drive yourself.