Quick answer: Most adults have cataract surgery awake and comfortable, without general anaesthesia. I use either a local block (peribulbar or retrobulbar), an injection around or behind the eye that numbs it completely, or numbing drops, sometimes with extra anaesthetic inside the eye. Mild sedation can be added for anxious patients, and general anaesthesia is kept for children and special cases.
Key Takeaways
- Cataract surgery is not expected to be painful; you may feel light pressure and see lights.
- A peribulbar or retrobulbar block numbs the eye fully and keeps it still; many patients do not even see the light.
- Numbing drops, with or without anaesthetic inside the eye, avoid an injection; you are more aware during surgery.
- Mild sedation through a small cannula helps anxious patients relax; it is not general anaesthesia.
- General anaesthesia is used for children and for adults who cannot cooperate or lie still.
Will I Be Awake During Cataract Surgery?
Yes, most adults are awake. Cataract surgery takes about 10–15 minutes, and modern local anaesthesia makes it comfortable without putting you to sleep. You may see bright light, colours or movement, and feel light pressure or cool fluid, but you will not see the instruments or feel pain. Being awake also means a faster recovery and going home within one to two hours.
What Are the Types of Anaesthesia for Cataract Surgery?
| Type | How it is given | What you feel | Suits |
|---|---|---|---|
| Peribulbar or retrobulbar block | A small injection of local anaesthetic around the eye (peribulbar) or behind it (retrobulbar), after numbing drops | The eye is fully numb and cannot move; vision is often dim, and many patients do not see the light | Patients who want maximum comfort, anxious patients, longer or more complex surgery |
| Topical anaesthesia | Numbing drops, sometimes with extra anaesthetic placed inside the eye (intracameral) | No injection; you see the light and are more aware, and can move the eye | Calm patients who can follow simple instructions; routine surgery |
| Mild sedation | Added to either method through a small cannula in the hand | Relaxed and drowsy, but still breathing on your own and able to respond | Anxious patients; decided case by case |
| General anaesthesia | Given by an anaesthetist; you are fully asleep | Nothing during surgery | Children; adults who cannot cooperate or lie still; special cases |
What Is a Peribulbar or Retrobulbar Block?
A peribulbar block is an injection of local anaesthetic into the tissues around the eye, not into the eye itself; a retrobulbar block places it a little deeper, behind the eye. Both work in a similar way. Numbing drops are given first, so the injection is usually felt only as brief pressure. Within a few minutes the eye becomes numb and stops moving, and vision becomes dim. Many of my patients prefer it because they feel nothing during surgery, and some do not even see the microscope light. The numbness and drooping of the eyelid wear off over a few hours.
A local block can be used in patients who take blood thinners. Sometimes it leaves a bruise around the eye (periorbital haematoma) or a red patch on the white of the eye (subconjunctival haemorrhage). These look worrying but are harmless and fade over one to two weeks. Serious complications from a block are rare. Double vision after surgery is uncommon; a 2026 meta-analysis found it slightly more often after injection blocks than after drops.
What Is Topical Anaesthesia?
With topical anaesthesia, the eye is numbed with drops only, so there is no injection. I sometimes add a small amount of preservative-free anaesthetic inside the eye at the start of surgery (intracameral anaesthesia). A Cochrane review found that adding intracameral lidocaine to drops reduced the chance of feeling any discomfort during surgery, without harming the cornea. With drops, you see the light and are more aware of the surgery, and I ask you to look at the light and keep still. More and more patients now choose topical anaesthesia, because it avoids the injection and the bruise, and vision returns faster on the day of surgery.
Local Block or Drops: Which Is Better for Me?
Both are safe and effective; the choice depends on you and your eye. I usually suggest a local block for patients who are very anxious, cannot keep the eye still, are sensitive to light, or have a more complex or longer operation, such as a very dense cataract or a small pupil. Drops suit calm patients having routine surgery, and patients who prefer to avoid an injection. A 2024 study in patients with heart disease found that topical anaesthesia caused a smaller rise in blood pressure and similar comfort. We decide together at your consultation.
Will I Need Sedation?
Not always. Mild sedation, given through a small cannula in the hand, helps anxious patients relax. It is not general anaesthesia: you keep breathing on your own and can still hear and respond. A 2025 meta-analysis found that intravenous sedation reduced pain compared with no sedation, with similar complication rates. Sedation is used with caution in some patients, for example those with dementia, where it can cause confusion, so I decide case by case.
When Is General Anaesthesia Needed?
General anaesthesia is not routine for adult cataract surgery, but it is the right choice in some situations:
- Children, including babies with congenital cataract
- Adults who cannot cooperate or lie still, for example because of severe tremor, advanced dementia, learning difficulties or severe claustrophobia
- Some complex operations, or when the surgeon and anaesthetist decide it is safer
General anaesthesia is given by an anaesthetist, with a pre-operative assessment and fasting instructions.
How Should I Prepare for the Anaesthesia?
- Have a light meal on the day of surgery unless told otherwise; if sedation or general anaesthesia is planned, we give you specific fasting instructions.
- Take your usual morning medicines with a sip of water, unless told otherwise.
- Do not stop blood thinners on your own; tell us which ones you take.
- Tell us about diabetes, heart or lung disease, allergies, previous problems with anaesthesia and prostate medicines such as tamsulosin.
- Tell us if you cannot lie flat, have a tremor or feel very anxious; we can adjust the plan.
- Bring a companion; you cannot drive home after surgery.
Read about cataract surgery for older adults and blood thinners.
What Happens After the Anaesthesia Wears Off?
With drops, the numbness wears off within an hour or so; with a peribulbar or retrobulbar block, it can take a few hours, and the eyelid may droop until then. Mild grittiness, watering or a scratchy feeling is common on the first day and usually settles quickly. Severe or increasing pain is not expected and should be reported straight away. A protective shield is worn while sleeping for the first five nights. Read the instructions after cataract surgery and the complete guide to cataract surgery.
Where Does Dr. Fouad El Sayyad See Patients?
- Sayyad Eye Center, Mohandeseen (main branch, where cataract surgery is performed): 3A Gameat El Dowal El Arabeya St., Sphinx Square.
- Sayyad Eye Center, New Cairo: Medical Park 2, opposite New Cairo Court.
To book an appointment with Dr. Fouad El Sayyad, call or WhatsApp 01000088168.
Frequently Asked Questions
Is cataract surgery painful?
No. With a local block or numbing drops, cataract surgery is not expected to be painful. You may feel light pressure or cool fluid, and if you feel any discomfort you can tell me and more anaesthetic is given.
Will I be awake during cataract surgery?
Most adults are awake, with local anaesthesia, and can go home within one to two hours. Mild sedation can help you relax. General anaesthesia is kept for children and special cases.
Which type of anaesthesia is best for cataract surgery?
There is no single best type. A peribulbar or retrobulbar block gives complete numbness and keeps the eye still; drops avoid an injection. The choice depends on your eye, your anxiety level and how complex the surgery is.
Does cataract surgery need general anaesthesia?
Usually not in adults. General anaesthesia is used for children, adults who cannot cooperate or lie still, and some special cases, after an assessment by the anaesthetist.
Can I have sedation during cataract surgery?
Yes. Mild sedation through a small cannula in the hand helps anxious patients relax. You keep breathing on your own. It is used with caution in some patients, such as those with dementia.
Is the injection around the eye painful?
Numbing drops are given first, so most patients feel only brief pressure. Within a few minutes the eye becomes numb, and you should not feel pain during the surgery.
Will I see the surgery?
No. You may see bright light, colours or movement, but not the instruments. With a peribulbar or retrobulbar block, many patients do not even see the light.
Can I have a local block if I take blood thinners?
Yes. A peribulbar or retrobulbar block can be used with blood thinners. Sometimes it causes a bruise around the eye or a red patch on the white of the eye, which is harmless and fades over one to two weeks.
Why is my eye bruised after cataract surgery?
A bruise around the eye or a red patch on the white of the eye can follow a local block, especially in patients on blood thinners. It does not affect the result of surgery and fades within one to two weeks.
Is local anaesthesia safe for elderly patients?
Yes. Local anaesthesia is the usual choice for older patients and avoids the risks of general anaesthesia. Heart conditions, breathing problems and medicines are reviewed before surgery so the plan suits you.
Can I eat before cataract surgery?
With local anaesthesia, a light meal is usually fine, and you take your usual medicines with a sip of water, unless told otherwise. If sedation or general anaesthesia is planned, follow the fasting instructions we give you.
How long does the numbness last?
Numbing drops wear off within about an hour. A peribulbar or retrobulbar block can last a few hours, and the eyelid may droop until it wears off. Mild grittiness on the first day is normal.
This article is for general education and does not replace an eye examination. Treatment decisions depend on your own eye assessment.
References
- Miller KM, Oetting TA, Tweeten JP, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2022;129(1):P1–P126.
- Minakaran N, Ezra DG, Allan BD. Topical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults. Cochrane Database Syst Rev. 2020;7(7):CD005276.
- Hanna A, Armstrong JJ, Kiatos-Tsioros E, et al. Intravenous vs nonintravenous sedation for cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg. 2025;51(8):723–730.
- Behera G, Kothari A, Subramanian A, et al. Comparing peribulbar and topical anesthesia in cataract surgery among patients with cardiovascular disease. Korean J Ophthalmol. 2024;38(1):71–76.
- Dhivagaran T, Butt F, Sharma S, et al. Incidence of postoperative diplopia after cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2026;133(7):921–931.
- Chen SP, Woreta F, Chang DF. Cataracts: a review. JAMA. 2025;333(23):2093–2103.
This article is for general education and does not replace an eye examination. Treatment decisions depend on your own eye assessment.
FAQS
-
Is cataract surgery painful?
No. With a local block or numbing drops, cataract surgery is not expected to be painful. You may feel light pressure or cool fluid, and if you feel any discomfort you can tell me and more anaesthetic is given.
-
Will I be awake during cataract surgery?
Most adults are awake, with local anaesthesia, and can go home within one to two hours. Mild sedation can help you relax. General anaesthesia is kept for children and special cases.
-
Which type of anaesthesia is best for cataract surgery?
There is no single best type. A peribulbar or retrobulbar block gives complete numbness and keeps the eye still; drops avoid an injection. The choice depends on your eye, your anxiety level and how complex the surgery is.
-
Does cataract surgery need general anaesthesia?
Usually not in adults. General anaesthesia is used for children, adults who cannot cooperate or lie still, and some special cases, after an assessment by the anaesthetist.
-
Can I have sedation during cataract surgery?
Yes. Mild sedation through a small cannula in the hand helps anxious patients relax. You keep breathing on your own. It is used with caution in some patients, such as those with dementia.
-
Is the injection around the eye painful?
Numbing drops are given first, so most patients feel only brief pressure. Within a few minutes the eye becomes numb, and you should not feel pain during the surgery.
-
Will I see the surgery?
No. You may see bright light, colours or movement, but not the instruments. With a peribulbar or retrobulbar block, many patients do not even see the light.
-
Can I have a local block if I take blood thinners?
Yes. A peribulbar or retrobulbar block can be used with blood thinners. Sometimes it causes a bruise around the eye or a red patch on the white of the eye, which is harmless and fades over one to two weeks.
-
Why is my eye bruised after cataract surgery?
A bruise around the eye or a red patch on the white of the eye can follow a local block, especially in patients on blood thinners. It does not affect the result of surgery and fades within one to two weeks.
-
Is local anaesthesia safe for elderly patients?
Yes. Local anaesthesia is the usual choice for older patients and avoids the risks of general anaesthesia. Heart conditions, breathing problems and medicines are reviewed before surgery so the plan suits you.
-
Can I eat before cataract surgery?
With local anaesthesia, a light meal is usually fine, and you take your usual medicines with a sip of water, unless told otherwise. If sedation or general anaesthesia is planned, follow the fasting instructions we give you.
-
How long does the numbness last?
Numbing drops wear off within about an hour. A peribulbar or retrobulbar block can last a few hours, and the eyelid may droop until it wears off. Mild grittiness on the first day is normal.
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