Anesthesia For Eye Surgery

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.

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

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