Local Anaesthesia for Eye Operations

Before you undergo and eye operation under local anaesthetic, you should check out this leaflet in order to give you an idea what is involved in this procedure. In addition, you will be provided with a step-by-step guide to how the anaesthetic will be given as well as monitored during the eye operation.

Anaesthesia– a state wherein pain will not be felt due to the effects of certain drugs. The word itself means ‘loss of sensation”.

Anaesthetic– drugs, in the form of drops, injections or gases, which are used to bring this painless state

Anaesthetists – physicians with specialist training in both local and general anaesthesia who monitors the condition of the patient before, during and after the surgery. Eye surgeons are usually trained to administer anaesthesia in eye surgeries.

Common Questions for the Anaesthetist

  • Who will administer the anaesthetic?
  • Have you used this kind of anaesthetic?
  • What risks are involved with this kind of anaesthetic?
  • What will I feel after the operation?

Local Anaesthesia

Drugs that render patients painless, local anaesthetics are usually given as injections and/or eye drops. Although you will be given this drug, you will remain awake and completely aware of everything but you will feel absolutely no pain.

Advantages of Local Anaesthesia

Local anaesthetics are quite effective during eye operations in preventing the feeling of pain. Aside from this, they can also provide you relief from pain after the operation is over. Compared to general anaesthesia, local anaesthesia has less side effects and risks especially for older patients. The reason is mainly because it does not involve other organs of your body such as the heart and lungs. In general, people usually recover more quickly after an operation that involved local anaesthesia and can even go home immediately after the operation. Local anaesthetics do not interfere with the action of prescribed medications that you might need to take and you can also drink and eat as usual.

General or Local Anaesthesia: Your Choice

Individuals who prefer to have a general anaesthesia have all the right to choose this option. Of course, it is important that you understand what is involved. You can discuss with your surgeon if you prefer general anaesthesia. You should know that there are certain medical conditions that prohibit operations under general anaesthesia and you may have to wait until this condition clears. There are also some hospitals that are not equipped with the proper facilities for operations done under general anaesthesia.

Who administers local anaesthesia?

Both eye surgeons and anaesthetists are sufficiently-trained to give local anaesthetic. Basically, there are two kinds:

  1. Some eye operations are done under local anaesthetics in the form of eye drops
  2. A lot of operations will require local anaesthetics in the form of injections and eye drops. The injections will ensure that the retina or even the entire will be still during the procedure while the eye drops will work to numb the eye surface. Usually, an injection will be given after the eye has been numbed by the eye drops.

Is the injection painful?

Since eye drops will be used to numb the eye surface, you will feel a very small sting or pressure that lasts for a few seconds.

Local Anaesthesia Complications

For eye operations, local anaesthesia is usually considered to be the safest for most people. It is normal for black eye or bruising to develop after the surgery mainly due to the blood vessels damaged by the injection. Although this is not considered to be serious, you will look a bit unsightly for a few days. Aspirin or blood-thinning drugs are usually given. On the other hand, if there is significant bleeding around your eye, your operation will be delayed until the bleeding subsides.

Serious complications are very, very rare and they usually are due to damage on the blood vessels or eye muscles or adverse effects on breathing, blood pressure and heart. If you want more information regarding these complications, your eye surgeon can provide you with the important details.

Who are unsuitable for eye operations under local anaesthesia?
Usually, local anaesthetics are not suitable for people who:

  • Have trouble staying still and lying flat for one hour
  • Have a medical condition such as Parkinson's Disease that prevents you from not moving
  • Have uncontrollable cough
  • Have serious hearing problems
  • Have difficulties understanding instructions
  • Suffers from severe claustrophobia
  • Have allergic reactions to drugs used as local anaesthetics

If one of these things applies to you, you should immediately speak with your anaesthetist or surgeon before the scheduled eye operation. General anaesthesia might be considered in cases like these and will entirely depend on your current health condition.

Before the Eye Operation

As soon as the operation is scheduled, a health check is necessary. Usually, a short questionnaire will be sent to you containing questions about your health. In some cases, you will be required to go to a clinic for pre-assessment. The clinic nurses will conduct the check up with a doctor standing by for consultation. Full medical history will be taken as your healthiness is assessed. If tests are needed, they will be arranged at the clinic. In addition, you will be asked about the situation at your home to ensure that you receive adequate support and care after the eye operation.

As part of the pre-assessment checked, you will be questioned about the following:

  • General fitness and overall health
  • heart disease
  • diabetes
  • lung disease
  • chest pain during exercise or while at rest
  • allergies
  • pregnancy
  • current medication
  • smoking habits
  • alcohol consumption

Day of the Eye Operation

On the scheduled operation, you will be given clear instructions regarding the food and drinks you should consume. Your prescribed medications will not be stopped unless you are taking blood-thinners such as clopidrogel, warfarin or aspirin. In this case, inform the hospital since you might be asked to discontinue these medications a couple of days before the scheduled operation. You should bring your medication with you in order for the doctor to check them.

In the Hospital

Your eye surgeon and anaesthetist will check your eye and mark it before the operation. The procedure will also be discussed in detail. After, you will be requested to sign the consent form. Usually, the side of the forehead where the target eye is will be marked.

What happens next?

A hospital gown will be provided but you can still choose to wear your own clothes. For this reason, you should wear clothes that are comfortable especially around the region of the neck.

  • You would be given eye drops for the dilation of your pupils although this will depend on the kind of operation you will be undergoing. The eye drops will slight make your vision blurry.
  • A local anaesthetic ointment or cream will be applied on the lower eyelid
  • It is recommended that you go to the toilet before the operation
  • You can choose to walk or be on a wheelchair or trolley when you go to the operation theatre

The staff will run some routine questions by you to check your identity. They will also check the consent form and the eye that will be operated on.

To Calm You Down

The entire staff including the surgeon and nurses will help you relax before the procedure. Sedatives are usually not given for they can make you sleepy and at the same time, slow down your breathing. These things night complicate the operation.

In the Anaesthetic Room

While lying on the trolley, the staff will ensure your comfort. The anaesthetist will then attach you to equipment that will monitor:

  • Blood pressure: via a cuff placed on the arm
  • Heart: via sticky patches placed on the chest (ECG or electrocardiogram)
  • Oxygen level: via a pulse oximeter which is clipped on the finger

The anaesthetist might also need to administer drugs via your vein. To accomplish this, a cannula (thin plastic tube) will be put into your vein on the back of your arm or hand using a needle and taped to prevent it from slipping out. To numb your eyes, your anaesthetist will administer local anaesthetics in the form of eye drops or sometimes injections.

Your eyes will then be kept closed to ensure that nothing will touch the eye surface. To ensure that the anaesthetic will spread evenly, one of the staff will massage it or a small weight will be placed over the eye.

Is the local anaesthetic working?

The eye surgeon or anaesthetist will check your eye to see if it has been numbed by the local anaesthetic. You will have to look in various directions to determine the effectivity of the anaesthetic. If everything seem to be working perfectly, you will now be taken to the operating room.

Inside the Operating Theatre

  • The staff will see if you are comfortable and check if your head is well-supported
  • To keep the area around the target eye clean, a sterile surgical sheet will be put over your face. There will be a hole on the sheet in order for the surgeon to see the eye being operated on.
  • For easier breathing, fresh air will be blown via a tube placed under the sheet.
  • Pulse and heart monitors will once again be attached.
  • A salt solution will be used to moisten your eyes so do not be surprised if you feel water streaming down at the side of your face.

If you feel nervous, one of the staff can hold hour hand and sit beside you during the operation.

 

During the Operation

It is not recommended that you talk to ensure that your face will not move. Remember that any movement might affect the operation. If you have to talk, you can signal to the surgeon by slightly moving your hand. The surgeon will then stop momentarily to hear what you have to say.

For the entirety of the operation, you will probably see some bright lights and movements but nothing will be seen in detail. You should expect some pressure since the surgeon will be using instruments that can reach inside. If you feel any discomfort, signal the staff and more local anaesthetic might be given if needed.

If you are worried about blinking, a tiny clip will be put on your eyelids to keep them open. if you are wearing a hearing aid, the surgeon might ask you to remove it as it can become wet and create noises.

After the Eye Operation

You will be seated in a wheelchair and escorted by a nurse to the ward. A shield or pad will cover your eye to ensure that you do not rub it as you sleep. Double vision is normal at this stage due to the lingering effects of the local anaesthetic.

You can choose to go home after you have fully-recovered and your transportation is ready. You will be given instructions involving post-op care such as activities to avoid. The medications that you need to take will also be discussed. If you are worried about putting eye drops, which will prevent infection and stop the swelling, properly, the nurse can show you how. Lastly, you will be instructed to return to see if everything is healing properly.

The effect of the local anaesthetic can last for as long as 4 hours and during this time, you will experience double vision. As for pain, you might feel some but a mild painkiller usually relieves it. Severe pain should be reported to your surgeon immediately. It is important that you have someone with you at home after the operation since you will still feel some discomfort.

Depending on your recovery, you can go back to driving after seeking your doctor's consent. Special care for your eye is also needed:

  • Do not rub your eyes
  • Wear eye shield to prevent you from rubbing your eye will sleeping
  • If your vision worsens or the pain becomes severe, immediately contact your doctor
  • Do not lift heavy objects
  • Do not go swimming or engage in strenuous exercise
  • Wear sunglasses especially during windy weather

Important notice