Living with Ménière’s disease is challenging enough—managing fluctuating hearing, So when the time comes to have cataract surgery, it’s completely natural to wonder how your balance might be affected. While cataract surgery is generally safe and brief, Ménière’s disease adds a layer of complexity that must be carefully managed.
In this guide, we’ll walk you through everything you need to know about cataract surgery if you also have Ménière’s disease. We’ll explore what to expect before, during, and after the procedure, and how your surgical team works to reduce dizziness, preserve stability, and support a smooth visual recovery.
What Is Ménière’s Disease and Why Does It Matter for Cataract Surgery?
Ménière’s disease is a chronic condition affecting the inner ear, which plays a critical role in both hearing and balance. It’s characterised by episodes of vertigo (spinning sensations), fluctuating hearing loss, tinnitus (ringing in the ears), and a feeling of pressure or fullness in the ear. The cause isn’t fully understood, but it’s believed to involve excess fluid in the inner ear—sometimes referred to as endolymphatic hydrops.
This matters for cataract surgery because the inner ear also helps regulate your balance. Any stress on your body—whether it’s surgery, medications, or even bright lights—can potentially trigger a flare-up. Add to that the fact that you’ll be lying flat during the procedure with bright lights shining directly into your eyes, and it’s easy to see why surgeons need to make a few adjustments when you have Ménière’s disease.
The Link Between the Eyes and Balance
Our sense of balance comes from a combination of three systems: the visual system (eyes), the vestibular system (inner ear), and the proprioceptive system (muscles and joints). When one of these systems isn’t functioning properly—as is the case with Ménière’s disease—the other two systems must work harder to compensate.
For people with Ménière’s, any sudden change in visual input—like that experienced after cataract surgery—can be destabilising. Even positive changes, such as clearer vision, may feel disorientating at first. This is particularly true if you’ve been relying heavily on blurry but consistent visual cues to help you balance.
Because of this, your ophthalmologist will plan your cataract surgery carefully, taking extra steps to reduce post-operative dizziness and allow your brain time to adjust to the new visual information.
Pre-Operative Planning: Communication Is Key
If you have Ménière’s disease, one of the most important things you can do is inform your cataract surgeon and anaesthetist well in advance. They’ll work together to tailor your surgical plan, aiming to reduce the risk of vertigo or disorientation during and after the procedure.
In your pre-operative consultation, your surgeon may ask about:
- The frequency and severity of your vertigo episodes
- Whether your symptoms are triggered by stress, lighting, or position
- How your hearing is affected
- Any medications you’re on to control symptoms
In some cases, your GP or ENT specialist may be involved as well, helping to adjust your Ménière’s treatment in the lead-up to surgery. You might be asked to stay on medications such as betahistine or vestibular suppressants to stabilise the inner ear before your operation.
Tailored Anaesthetic Options to Avoid Dizziness
Cataract surgery is typically performed under local anaesthetic—often in the form of eye drops or a small injection around the eye. This means you’re awake during the procedure, but you don’t feel pain. For those with Ménière’s disease, remaining awake is usually preferred, as general anaesthesia can sometimes trigger balance issues post-operatively.
If you are especially prone to vertigo, your anaesthetist might:
- Choose sedatives with minimal impact on the inner ear
- Avoid head tilting that could affect inner ear fluid
- Ensure you’re not overly anxious, as stress can be a known trigger
Some patients may benefit from a slight elevation of the head during surgery rather than lying perfectly flat, which can help with inner ear fluid distribution and reduce dizziness.
What Happens During the Surgery?
The procedure itself takes around 15–20 minutes. You’ll be lying on your back under a bright surgical microscope. The team will likely take special precautions to ensure you remain as comfortable and stable as possible.
A few ways your surgeon may adapt the procedure for Ménière’s patients include:
- Keeping the room calm and noise levels low to avoid auditory overstimulation
- Using a shorter-acting sedative only if necessary
- Applying eye drapes gently to reduce pressure sensations
While these might seem like small adjustments, they can make a big difference when it comes to preventing post-op dizziness.
Managing Post-Operative Vertigo: What to Expect
After the surgery, your brain and vestibular system will need to recalibrate to the new visual input. This recalibration can sometimes make symptoms like vertigo, imbalance, or spatial disorientation feel worse for a few days.
To minimise this, your care team may suggest:
- Keeping both eyes open as much as possible (to avoid visual mismatch)
- Avoiding rapid head movements
- Resting with your head slightly elevated
- Continuing vestibular medications if prescribed
It’s also helpful to have someone stay with you for the first 24–48 hours after surgery. If vertigo does occur, it’s often short-lived and manageable, but having support nearby can offer reassurance.
Recovery and Adaptation: Give It Time
The first week after cataract surgery is usually focused on healing and adjusting to your new vision. If you’ve been using your vision as a crutch for balance, you might find your body needs a bit longer to adapt.
Fortunately, many patients with Ménière’s find their vertigo doesn’t flare significantly during recovery if proper precautions are taken. If you do experience spinning sensations, they usually resolve within a few days. Anti-vertigo medications or vestibular physiotherapy exercises may be used to speed up this adaptation phase.
Your vision will continue to improve over several weeks, and your balance should gradually stabilise as your brain adapts to the clearer input from your eyes.
One Eye or Both? A Staged Approach May Help
If you need cataract surgery in both eyes, it’s often recommended to operate on one eye first and allow your body time to adjust. This is especially important for patients with Ménière’s, since too many visual changes at once can overwhelm the brain’s balance system.
A staged approach allows:
- Visual input to rebalance gradually
- Your ENT team to monitor any flare-ups
- You to regain confidence before the second surgery
Surgeons typically wait a few weeks before proceeding with the second eye, especially in patients with a history of post-op vertigo.
When to Seek Help After Surgery
While some dizziness or imbalance is expected, there are certain signs that warrant immediate medical advice. These include:
- Sudden, severe vertigo that lasts for hours
- Vomiting or inability to stand upright
- Sharp or worsening eye pain
- Vision that doesn’t improve or gets worse
In rare cases, a post-op complication like elevated eye pressure or infection can mimic Ménière’s symptoms. Always err on the side of caution—your eye surgeon or GP can quickly rule out anything serious
Frequently Asked Questions (FAQs)
- Can Ménière’s disease make cataract surgery more risky?
Ménière’s disease doesn’t increase the surgical risk in terms of complications like infection or vision loss, but it can make the experience more challenging. That’s because your inner ear is already sensitive to changes in your environment, and the visual adjustments that come with cataract surgery can trigger vertigo or imbalance. Your medical team will take steps to manage these risks by tailoring the surgical approach and closely monitoring your symptoms throughout the process. - Should I delay cataract surgery if I’m having frequent Ménière’s flare-ups?
Yes, it’s usually wise to postpone surgery during periods of unstable Ménière’s activity. If you’re experiencing frequent or severe vertigo episodes, it could make recovery more difficult and increase the likelihood of post-operative dizziness. Your surgeon may recommend waiting until your symptoms have been stable for several weeks before scheduling the operation, giving your body the best chance to adapt calmly to the changes in vision. - Will I be dizzy after cataract surgery?
Some people with Ménière’s disease do experience dizziness or disorientation after cataract surgery, particularly in the first few days. This happens because the brain must adjust to the sudden improvement in visual input, which can feel unfamiliar or overwhelming at first. The good news is that most people find these symptoms are temporary and manageable with rest, proper medication, and support from their healthcare team. - Can I take my Ménière’s medications before and after surgery?
In most cases, yes—you should continue taking your prescribed Ménière’s medications such as betahistine unless told otherwise by your doctor. These medications help keep inner ear fluid pressure more stable and may reduce the chance of a vertigo flare. However, it’s important to tell both your cataract surgeon and your ENT consultant about all the medications you’re on so they can avoid drug interactions and ensure a smooth perioperative plan. - Is general anaesthesia safer for patients with Ménière’s disease?
General anaesthesia is not usually preferred for people with Ménière’s disease because it can temporarily depress inner ear function and cause post-operative dizziness. Local anaesthesia, often in the form of eye drops or a small injection, allows you to remain awake and is associated with fewer balance-related side effects. If mild sedation is needed to keep you calm, your anaesthetist can choose medications that have minimal impact on your vestibular system. - How long should I wait before having surgery on the second eye?
A staged approach is typically recommended for patients with Ménière’s disease, with several weeks between operations on each eye. This allows your balance system time to adapt to the changes brought on by the first procedure, reducing the chance of prolonged disorientation. Your surgeon will assess how well you recover after the first surgery before advising on the right timing for the second eye. - Can cataract surgery improve balance in any way?
Interestingly, yes—once your brain has adjusted, the clearer visual input from cataract surgery can actually help support balance. Vision is a major contributor to spatial orientation, and people who’ve been compensating for blurred or cloudy sight may find that better vision improves their overall sense of steadiness. However, this benefit is not always immediate and may take days or weeks to fully settle. - Will I need extra support at home after surgery?
It’s definitely a good idea to have someone with you for at least the first day or two after surgery. Even if your vertigo doesn’t flare, having a companion nearby can make basic tasks easier and reduce the risk of injury from imbalance. They can also help monitor your recovery, ensure you take your medications as prescribed, and support you in the event any dizziness or nausea occurs. - What kind of follow-up should I expect after surgery?
You’ll usually return to your cataract surgeon for a follow-up appointment within one week of your procedure. This visit allows your surgeon to check the healing process, assess your vision, and address any early concerns—including those related to balance or dizziness. If Ménière’s symptoms worsen after surgery, your ENT consultant may also be involved in managing the situation and adjusting your medications if needed. - Can vestibular physiotherapy help after cataract surgery?
Yes, vestibular physiotherapy—or balance rehabilitation—can be particularly useful if you’re experiencing persistent imbalance or vertigo after cataract surgery. These therapies are designed to help your brain and body retrain their balance mechanisms through specific exercises. Your ENT specialist or GP can refer you to a physiotherapist who understands Ménière’s disease and can tailor the programme to your unique post-operative needs.
Final Thoughts
Cataract surgery can be done safely and successfully in people with Ménière’s disease, but it does require a thoughtful, customised approach. The key is communication—between you, your eye surgeon, your anaesthetist, and your ENT specialist if needed.
At London Cataract Centre, we understand how inner ear conditions like Ménière’s can make even routine eye procedures feel daunting. We take every step to ensure your surgery is not just successful, but also comfortable and safe for your balance system.
If you’re considering cataract surgery and have Ménière’s disease, we’d be happy to talk you through the options and create a care plan tailored to you.
References
- Supuk, E., Alderson, A., Davey, C.J., Green, C., Litvin, N., Scally, A.J. & Elliott, D.B., 2016.
Dizziness, but not falls rate, improves after routine cataract surgery: the role of refractive and spectacle changes. Ophthalmic and Physiological Optics, 36(2), pp.183–190.
Available at: https://pubmed.ncbi.nlm.nih.gov/26549158/
- ScienceDaily (re: Wiley), 2015.
Cataract surgery lessens patients’ dizziness. ScienceDaily. Summarises evidence from the Supuk et al. study showing significant reduction in dizziness post-surgery.
Available at: https://www.sciencedaily.com/releases/2015/11/151124143339.htm - Harvard Health Publishing, 2023.
Ménière’s disease – Diagnosis and treatment. Harvard Health Publishing. Provides clinical overview of Ménière’s disease, including vertigo, hearing symptoms, and therapeutic approaches.
Available at: https://www.health.harvard.edu/a_to_z/menieres-disease-a-to-z
- Wikipedia contributors, 2025.
Ménière’s disease. Wikipedia. While not a primary source, the article cites peer-reviewed literature regarding inner‑ear fluid imbalance and surgical options such as endolymphatic sac decompression.
Available at: https://en.wikipedia.org/wiki/M%C3%A9ni%C3%A8re%27s_disease