If you’re living with thrombocytopenia and you’ve been told you need cataract surgery, it’s natural to feel a bit anxious. Cataract surgery is already something that can feel daunting — and when you add a bleeding disorder into the mix, the questions start piling up. Can it still be done? What are the risks? How do surgeons plan around low platelet counts? The good news is that with the right approach, cataract surgery can still be very safe and successful for patients with thrombocytopenia.
This guide is written with you in mind. We’ll walk through what thrombocytopenia actually means for your surgery, how your care team prepares for it, and what steps are taken before, during, and after the procedure to ensure the best outcome. You’ll also find a helpful FAQ section at the end that tackles common questions patients ask.
Understanding Thrombocytopenia and Its Relevance to Cataract Surgery
Thrombocytopenia is a condition where your blood has fewer platelets than normal. Platelets are the components in your blood that help it clot, so having a low count can make you more prone to bruising and bleeding. While cataract surgery is minimally invasive — usually involving a small incision in the eye — any surgical procedure, however minor, comes with a bleeding risk. In thrombocytopenia, this risk is elevated and requires additional precautions.
It’s also important to know that not all thrombocytopenia is the same. Some people have mild cases and may not even notice symptoms. Others have more severe reductions in platelet count, either due to autoimmune conditions like ITP (immune thrombocytopenia), bone marrow disorders, medication side effects, or chemotherapy. Whatever the underlying cause, it needs to be factored into your surgical plan.
In ophthalmology, bleeding complications during or after surgery can affect vision outcomes — so controlling that risk is a top priority. Fortunately, cataract surgery is typically performed without cutting into blood-rich tissues, which significantly reduces the chance of a major bleed. Still, preparation and close collaboration between your ophthalmologist, haematologist, and possibly your GP are key.
Preoperative Assessment: Building a Safer Surgical Plan
The first step in managing cataract surgery for someone with thrombocytopenia is a thorough preoperative assessment. This means more than just checking your vision and cataract density. It involves a full medical review, blood tests, and often a letter or input from your haematologist, especially if your platelet count has fluctuated in the past.
Surgeons will want to know the cause of your thrombocytopenia, your most recent platelet count, and whether it’s stable. A count above 100,000 platelets per microlitre is usually considered safe for surgery. However, cataract surgery may still proceed in patients with platelet counts as low as 50,000 under the right precautions — especially if the benefits of improving your vision outweigh the bleeding risks.
In some cases, your haematologist may recommend treatment to raise your platelet count in the days leading up to surgery. This might involve corticosteroids, intravenous immunoglobulin (IVIG), or platelet transfusions, depending on the cause and severity of your condition.
Modifying Surgical Technique for Safety
Although standard cataract surgery is typically bloodless, certain adjustments are made for patients with thrombocytopenia to reduce any possible bleeding risk further. Most surgeons will opt for a small-incision phacoemulsification technique, which involves a 2-3 mm incision and very little disruption to surrounding tissues. This approach helps minimise trauma and speeds up recovery.
The anaesthetic method may also be adjusted. Local anaesthesia is usually preferred in cataract surgery, often given as topical drops or a small injection near the eye. However, for patients with severe thrombocytopenia, some types of local anaesthetic (like retrobulbar or peribulbar blocks) are avoided due to the small chance of bleeding behind the eye. Surgeons might instead use sub-Tenon’s anaesthesia or stick with purely topical anaesthetic drops, which carry even less risk.
In high-risk cases, surgery might even be performed in a hospital setting rather than a day clinic, allowing for immediate access to blood products and monitoring if needed. The aim is always to strike the right balance — avoiding unnecessary hospitalisation but ensuring full preparedness.
Intraoperative Considerations: What Happens During Surgery
Once in surgery, your eye will be numbed and the area cleaned thoroughly to prevent infection. The incision made is self-sealing, and very little tissue is disturbed during the lens removal and IOL (intraocular lens) implantation process. Bleeding is uncommon, but your surgeon will be alert to any signs of subconjunctival haemorrhage (bleeding under the surface of the eye), which while visually dramatic, is usually harmless and resolves on its own.
Surgical time is generally short — often under 20 minutes — and most patients are awake and comfortable throughout the process. Your blood pressure and heart rate will be monitored, particularly if you’re nervous or prone to spikes that could complicate bleeding risk.
If there’s any concern during surgery, the team will be prepared to stop and reassess. This is why it’s so important that your surgeon is aware of your platelet status and that all safety measures are in place from the beginning.
Postoperative Care: Recovery and Bleeding Risk
After cataract surgery, the main focus is on healing and avoiding complications. For patients with thrombocytopenia, the risk of bleeding remains — particularly in the first few days. Although internal eye bleeding is rare, surface bruising or bleeding from the conjunctiva may occur and look alarming. Fortunately, it’s usually self-limiting.
You’ll be prescribed anti-inflammatory and antibiotic eye drops, which you should take exactly as instructed. These help reduce swelling and prevent infection — both of which can affect the healing process. Your surgeon may also advise against rubbing your eye, bending down too much, or doing anything strenuous for the first week, as these could increase pressure inside the eye and heighten bleeding risk.
Some haematologists may also monitor your platelet count during this time, particularly if you received a transfusion or any pre-surgical treatment. Keeping them in the loop during recovery is just as important as before surgery.
When Platelet Counts Are Critically Low: Special Measures
In patients with severe thrombocytopenia (platelet counts below 30,000), the surgical team will need to consider more intensive precautions. Surgery may be delayed while the count is stabilised. In some cases, platelet transfusions are given shortly before the procedure — and sometimes even during it, depending on how long they’re expected to last.
You may be admitted to a hospital rather than attending a day surgery unit, with full anaesthetic and haematology backup on hand. While this adds to the logistics and preparation, it ensures your safety is prioritised.
In some situations, where vision is severely compromised and there is no way to raise platelet counts sufficiently, the risks and benefits must be weighed very carefully. Your eye surgeon and haematologist will need to have an open discussion with you about the best course of action.
How to Prepare for Cataract Surgery When You Have Thrombocytopenia
Knowing what to expect can make a big difference in how you approach surgery — especially if you have a bleeding disorder like thrombocytopenia. Preparing properly not only reduces risks but can also help you feel more in control. The first step is to gather all your relevant medical records. This includes your most recent blood test results, details of your diagnosis, and any treatment you’re receiving (such as corticosteroids or regular transfusions). Your surgeon will need this to coordinate safely with your haematologist.
Next, attend your preoperative consultation with a list of questions. Ask about the type of anaesthesia, how bleeding will be managed, whether hospital backup is available if needed, and what signs to watch for after surgery. Bring someone with you if you’re likely to feel overwhelmed — two pairs of ears are always better than one when absorbing detailed information. If platelet-raising treatment is needed beforehand, make sure this is booked well in advance and that all parties are aligned.
Finally, plan your post-op period carefully. Arrange for transport home after surgery, have your prescribed drops ready to go, and avoid any strenuous activity for at least the first few days. Stock up on soft tissues (as you may have some watery discharge), and sleep with your protective shield on as advised. The more prepared you are, the smoother and more reassuring the whole experience will be.
Communicating with Your Surgical Team
One of the most important things you can do as a patient is to be open and clear with your medical team. Let your cataract surgeon know about your condition as early as possible. Provide them with any documentation or contact information for your haematologist. If you’re under regular monitoring, make sure recent bloodwork is shared between both teams.
Ask questions, voice concerns, and don’t hesitate to raise any symptoms you’re experiencing, even if they seem minor. In this context, a collaborative approach makes all the difference. It also helps your care feel less clinical and more personal — which is exactly what it should be.
FAQ: Cataract Surgery in Patients with Thrombocytopenia
- Is cataract surgery safe if I have thrombocytopenia?
Yes, cataract surgery can still be performed safely if you have thrombocytopenia, but it does require additional planning. Your care team will assess your current platelet count, consult with your haematologist, and may adjust the anaesthetic or surgical technique to reduce bleeding risks. Most surgeries are completed without any complications when these precautions are in place. - What is the minimum platelet count needed for cataract surgery?
Generally, a platelet count above 100,000 is ideal, but many surgeons are comfortable operating with counts above 50,000, especially if the surgery is straightforward. If your platelet count is lower, your haematologist may recommend treatment to raise it temporarily before surgery, such as steroids or transfusions. - Will I need a platelet transfusion before surgery?
This depends on the severity of your thrombocytopenia. Patients with very low counts — typically below 30,000 — may be advised to receive a platelet transfusion shortly before surgery to minimise bleeding risks. Your haematologist will make this decision based on your individual case. - Can I have local anaesthesia safely?
Yes, but the type of local anaesthesia may be tailored to reduce the risk of bleeding. For example, topical anaesthetic drops or sub-Tenon’s injections are preferred over retrobulbar injections, which carry a slightly higher risk of internal eye bleeding. Your surgeon will choose the safest method based on your condition. - How long does recovery take if I have thrombocytopenia?
Recovery time is usually the same as in other patients — about four to six weeks for full visual recovery. However, you may need closer follow-up, particularly in the first few days after surgery, to ensure there are no bleeding complications or signs of infection. - Can bleeding during surgery affect my vision?
Significant internal bleeding is very rare in cataract surgery, even in patients with thrombocytopenia. If minor bleeding occurs on the surface of the eye (such as subconjunctival haemorrhage), it might look alarming but generally does not affect vision and resolves on its own. - Will my medications need to be adjusted before surgery?
Some medications, such as blood thinners, may need to be paused or adjusted in coordination with your haematologist before surgery. This should be discussed well in advance, as stopping or changing your medications without medical advice can be risky. - Can I have both eyes operated on at once?
Usually, surgeons prefer to operate on one eye at a time in patients with thrombocytopenia, especially if there are concerns about healing or bleeding. Once the first eye has healed without complications, the second can be scheduled. - Will I be put to sleep for the surgery?
Cataract surgery is typically performed under local anaesthesia while you’re awake. However, if you are extremely anxious or your condition requires hospital-based care, general anaesthesia might be considered. This is rare but can be discussed on a case-by-case basis. - How can I find a surgeon experienced in dealing with thrombocytopenia?
Start by looking for centres that handle complex cataract cases or have close ties with haematology departments. Our clinic has extensive experience managing patients with co-existing medical conditions and can offer tailored treatment plans in collaboration with your wider healthcare team.
Final Thoughts
Thrombocytopenia doesn’t have to be a barrier to getting your vision back. With careful planning, coordination between your healthcare teams, and minor adjustments to how surgery is approached, most patients can safely undergo cataract surgery with excellent results.
If you’re living with this condition and considering treatment, don’t let fear stop you from exploring your options. Ask the right questions, make sure your team knows your full medical history, and take the steps needed to prepare. At London Cataract Centre, we’ve helped many patients with complex medical conditions — including blood disorders — regain their vision with confidence. You’re not alone in this journey, and the right team will guide you every step of the way.
References
- Barequet, I.S., Sachs, D., Shenkman, B., et al. (2011) ‘Risk assessment of simple phacoemulsification in patients on combined anticoagulant and antiplatelet therapy’, Journal of Cataract & Refractive Surgery, 37(8), pp. 1434–1438. doi:10.1016/j.jcrs.2011.02.035. Available at: PubMed (https://pubmed.ncbi.nlm.nih.gov/21684111/
- Grzybowski, A., Ascaso, F.J., Kupidura‑Majewski, K. & Packer, M. (2015) ‘Continuation of anticoagulant and antiplatelet therapy during phacoemulsification cataract surgery’, Current Opinion in Ophthalmology, 26(1), pp. 28–33. doi:10.1097/ICU.0000000000000117. Available at: PubMed https://pubmed.ncbi.nlm.nih.gov/25390860/
- Kobayashi, H. (2010) ‘Evaluation of the need to discontinue antiplatelet and anticoagulant medications before cataract surgery’, Journal of Cataract & Refractive Surgery, 36(7), pp. 1115–1119. doi:10.1016/j.jcrs.2010.01.017. Available at: PubMed https://pubmed.ncbi.nlm.nih.gov/20610088/
- Anticoagulants and antiplatelet drugs during cataract surgery (2022), Indian Journal of Ophthalmology. Available at: PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9789829/
- Anticoagulants and antiplatelet drugs during cataract surgery (SciELO summary), Arq Bras Oftalmol (2018). Available at: SciELO https://www.scielo.br/j/abo/a/nSVWks3YJtR7VPQCjYhzZCd/