When is eye surgery performed?

Eye surgery may be performed where there is a danger of losing your sight due to a disease, injury or degenerative condition, or to improve your sight where you have problems such as short or long sight or astigmatism. Eye surgery can give you freedom from glasses and contact lenses, so can be an attractive option if reliance on vision aids bothers you.

Many eye operations are performed on older people to help with the problems associated with aging eyes, such as cataracts, macular degeneration and glaucoma. Clearly there are increased risks when operating on older people, as they will be frailer, more prone to infection and may not recover as quickly as they once did.

Weighing the risks

In all cases, surgery will only be considered where the benefits outweigh the risks. For example, if you could lose your sight due to retinal detachment, then clearly the risks from reattachment surgery are worth taking. However, if you are already at increased risk due to other health reasons, such as diabetes or immune deficiencies, then surgery that is solely to correct your vision so that you don’t have to wear glasses is probably not worth risking.

Risks of traditional eye surgery

There are a number of risks associated with traditional eye surgery, such as vitreoretinal surgery. These include:

• Infection - as with any invasive surgery, eye surgery carries a risk of infection at the wound site.
• Retinal tears or detachment – disturbing the eye can cause problems with the retina.
• Glaucoma – due to fluid becoming trapped behind the cornea.
• Cataracts – vitreoretinal surgery often increases the risk of cataracts.
• Floaters – caused by bleeding into the vitreous.

If your surgery involves an implant, such as a replacement lens or an implantable contact lens, then there is also a risk that your body may reject the implant, causing symptoms such as inflammation, reddening and pain.

Risks of laser eye surgery

Laser eye surgery, such as PRK, LASIK and LASEK are far less invasive than some traditional surgery methods, and so the risk of infection is significantly reduced, and there is less chance of the retina being disturbed during the procedure.

The main risks from laser surgery include:

• Dry eyes – which may persist for up to six months.
• Over or under correction – requiring further surgery.
• Ptosis – a temporary drooping of the upper eyelid.
• Reduced night vision – along with problems of glare, halos and starbursts around bright objects.
• Infection (in PRK and LASEK) – where the surface of the cornea is removed or disturbed.
• Unstable corneas – if too much of the cornea is removed.
• Flap problems (LASIK) – where the flap cut for the treatment fails to heal properly or becomes detached.

Factors that increase your risk

There are several factors that will increase the risks from eye surgery, including:

• Diabetes.
• Immune system diseases, such as HIV and rheumatoid arthritis.
• Multiple eye conditions (where the presence of one disrupts the treatment for another).
• Your prescription – the more shortsighted you are, the more prone you will be to problems of thin corneas and retinal detachment.
• Your age – as discussed above, older people heal slower and are more vulnerable to damage and disease. 

Reducing the risks of eye surgery

The best way to reduce the risks of complications from your eye surgery is to go to a reputable clinic and a reliable surgeon and then follow the instructions you are given following your operation. These will usually include advice such as:

• Do not rub or poke your eye.
• Avoid getting soapy water in your eye.
• Avoid vigorous activity or contact sports.
• Do not go swimming.
• Do not use eye make up.

How long you need to follow this advice will vary depending on your operation, but you generally have to take extra care around your eyes for at least two weeks.