It’s completely normal to feel a bit wobbly before cataract surgery. The good news is that the procedure itself is quick, you’re awake, and most people describe it as “odd but comfortable” rather than painful. Still, if nerves are kicking in, you might be wondering about medication to take the edge off. In this guide, I’ll walk you through the mild sedatives and anti-anxiety options that are commonly used in the UK, how they fit alongside local anaesthetic, who they suit best, and why heavy sedation is usually unnecessary for cataract surgery. By the end, you’ll know exactly what to expect and how to talk to your surgical team about the level of support that feels right for you.
The very short answer
For most patients in the UK, cataract surgery is done under local anaesthetic (numbing drops and/or a small injection around the eye) with no need for strong sedation. If you’re anxious, your team may offer a mild oral benzodiazepine such as temazepam, diazepam, or lorazepam before surgery. Some centres instead use tiny, carefully titrated amounts of midazolam given into a vein during the procedure. These medicines reduce anxiety and help you relax, but they’re kept light so you can cooperate, breathe on your own, and go home the same day.
Why cataract surgery usually doesn’t need heavy sedation
Cataract surgery is one of the safest and most frequently performed procedures in modern medicine. It’s designed as a day-case operation with a very short theatre time (often around 10–20 minutes once you’re on the table). Because you’re awake, your surgeon can ask you to keep your eyes still or look at a particular light. You won’t see instruments coming towards you—just a bright glow—thanks to the microscope and the way light is focused in the eye.
Heavy sedation (or a general anaesthetic) can make it harder for you to cooperate and can slow recovery afterwards. It also adds risks that simply aren’t necessary for the vast majority of people. That’s why most centres prefer light-touch approaches: excellent local anaesthesia, gentle communication, and, only if needed, a small dose of an anxiolytic.
How the anaesthetic part works (and where anxiety meds fit)
Think of your care on the day as two layers:
- Local anaesthetic to block pain
This is the foundation. Numbing drops are placed on the eye, and some surgeons add a small injection around the eye (sub-Tenon’s or peribulbar block) for extra comfort and to reduce movement. Local anaesthetic alone is usually enough to make the procedure comfortable. - Optional anxiolysis (relaxation)
If you’re nervous, the team may offer:- Oral benzodiazepine (tablet or liquid) given about 30–60 minutes before theatre.
- Intravenous (IV) midazolam in tiny, titrated doses during the procedure.
These medications don’t replace the local anaesthetic. They simply help you feel calmer, slow racing thoughts, and soften the “butterflies” you might feel in the waiting area or once you’re under the surgical microscope.
The most common medications used
1) Temazepam (oral)
Temazepam is frequently used in UK day-surgery settings. It’s short-acting compared with some other options, which makes it well suited to a brief procedure. Patients describe a pleasant relaxation and a mild drowsiness without feeling “knocked out.” Dosing is conservative and adjusted for age, frailty, and other medicines you take. You’ll need a responsible adult to accompany you and you must not drive after receiving it.
2) Diazepam (oral)
Diazepam can be offered where a slightly longer-lasting calming effect is helpful. It has an excellent track record for reducing pre-operative anxiety. Because its effects can linger, clinicians use small doses and consider your age, weight, and overall health. Again, you’ll need an escort home and should avoid driving or signing important documents for a period advised by your team.
3) Lorazepam (oral or sublingual)
Lorazepam is another well-known anxiolytic. Some centres prefer its predictability and the fact it can be given under the tongue if swallowing a tablet is difficult. Like the others, doses are kept low for day-case eye surgery and tailored to you.
4) Midazolam (intravenous, tiny doses)
Midazolam is popular with anaesthetists because it can be titrated drop-by-drop while they watch how you respond. The aim is minimal sedation: you’re relaxed and less aware of the time passing, but you can still follow simple instructions (“look at the light”, “keep still”). This is not the same as a general anaesthetic.
5) Less common or adjunctive options
- Hydroxyzine: an antihistamine with anxiolytic properties; used less commonly for cataract surgery but may be considered if benzodiazepines aren’t appropriate.
- Propranolol: not an anti-anxiety medicine per se, but can blunt the physical symptoms of adrenaline (racing heart, shaky hands) for some patients. It’s only used selectively and isn’t standard.
- Melatonin: occasionally used to promote calm and sleep the night before in very anxious patients, though it isn’t a primary anti-anxiety medicine for the day of surgery.
- Nitrous oxide (“gas and air”): not typically used for cataract surgery in the UK; local anaesthesia plus minimal sedation is preferred.
Your team will choose what’s safest and most suitable for you—or decide that you simply don’t need anything beyond kind, steady reassurance and numbing drops.
Who is most likely to be offered a sedative?
- People with significant procedural anxiety who feel that their nerves could make it hard to lie still.
- Those with previous difficult experiences in medical settings who know a small dose helps them cope.
- Patients with tremor, movement disorders, or high startle responses, where relaxation helps the surgery go smoothly.
- Patients who strongly prefer light sedation after discussing risks and benefits and meeting criteria for safe day-case care.
It’s never “one size fits all”. Many people are surprised at how calm they feel in theatre once the team starts talking them through each step.
When a general anaesthetic might be considered
A general anaesthetic is unusual but can be appropriate in specific scenarios—for example, in patients who cannot lie flat, have severe claustrophobia that does not respond to light sedation, or have certain neurological or cognitive conditions that make cooperation impossible. If this applies to you, your surgeon and anaesthetist will weigh the risks and benefits carefully and plan monitoring and recovery accordingly. For the typical patient, general anaesthetic is unnecessary.
Safety first: what your team checks before giving any anxiolytic
- Your medical history: including sleep apnoea, chronic lung disease, heart conditions, liver/kidney problems, and any past reactions to sedation or anaesthesia.
- Your medication list: benzodiazepines can interact with opioids, some sleep medicines, and alcohol. Your clinicians will adjust plans to avoid excessive sedation.
- Your age and frailty: older adults are more sensitive to these medicines, so doses are smaller and observation is careful.
- Your escort and travel home: you must have a responsible adult to take you home and stay with you for the period advised by your unit.
- Consent: proper consent is ideally taken while you are fully alert; if you’ve had a sedative, the team ensures you still have capacity and understand what you’re agreeing to.
What will it feel like if you take a pre-op anxiolytic?
Expect to feel calmer, less keyed-up, and a bit drowsy. Time can pass faster than usual. You’ll still be aware of your surroundings, and you’ll hear the team talking to you. Many patients report feeling pleasantly relaxed and surprised when told “That’s it—we’re all done.” Some have patchy memory of the theatre time, especially with IV midazolam, which is normal.
Why clinicians keep sedation “light” for eye surgery
Ophthalmic surgery is delicate and benefits from your cooperation—keeping still, not squeezing the eyelids, following the request to “look towards the light”. Light sedation preserves your breathing and protective reflexes, reduces nausea, and lets you get home sooner. Heavier sedation or general anaesthesia increases the risk of low oxygen levels, blood pressure swings, post-operative confusion (especially in older adults), and a longer recovery. The aim is comfort and safety, in that order.
If you’re especially anxious: practical strategies that really help
Medication is only one part of the toolkit. These non-drug approaches, used well, can transform the experience:
- Ask for a pre-op chat with the nurse or anaesthetist to walk you through the sequence: drops, drape, light, sounds, time. Predictability calms the nervous system.
- Breathing technique: slow nasal inhale to a count of four, longer exhale to six. This taps into your vagal system and lowers adrenaline.
- Distraction in theatre: some units play music or talk you through each step in a reassuring way.
- Hand-hold or verbal anchor: a staff member can keep a gentle dialogue going (“you’re doing perfectly, just keep looking at the light”).
- Plan your escort and the evening: a favourite meal, a quiet space, and no big decisions to make afterwards.
Plenty of patients get through the day with just these measures and local anaesthetic drops.
Special situations your team will tailor for
- Sleep apnoea or snoring: sedation can worsen breathing pauses; anaesthetists use the lowest effective dose and careful monitoring.
- Narrow-angle glaucoma: some medicines used around the time of surgery are adjusted; your surgeons already plan for this.
- Parkinson’s disease or essential tremor: timing of Parkinson’s meds and gentle anxiolysis can help you stay still.
- Dementia or cognitive impairment: the consent process and sedation plan are individualised; sometimes a general anaesthetic is considered.
- Severe back problems or inability to lie flat: wedges, pillows, and a slightly head-up position can be used; occasionally GA is chosen.
What about the second eye?
Many people find the second eye even easier. You know the routine, the mystery is gone, and anxiety is naturally lower. If you had a small dose of medication the first time and liked the effect, you can request the same again; equally, you may decide you don’t need it.
On the day: a simple step-by-step flow
- Arrival and check-in: you’ll confirm details, have your eye measured/marked, and review your medication list.
- Drops: dilating and numbing drops are given.
- Optional tablet: if agreed, a mild anxiolytic is administered and you rest in a comfy chair while it takes effect.
- Theatre: monitors on, more numbing if needed, sterile drape goes over the eye area (with plenty of air space).
- Surgery: you look at the light, the team talks to you, and the lens is removed and replaced.
- Recovery: brief rest, instructions given, and you go home with your escort.
Side effects you should know about
With the small doses used, side effects are usually mild and short-lived: sleepiness, slower reaction time, and a bit of forgetfulness are most common. Rarely, people feel light-headed or nauseated. You shouldn’t drive, operate machinery, or sign important documents until the next day (or as your unit advises). If you have sleep apnoea, COPD, or significant heart disease, your team will monitor you closely and keep sedation ultra-light.
How to decide if you want medication
Ask yourself:
- Am I likely to be unable to lie still without it?
- Would a gentle sense of calm make the experience more manageable for me?
- Do I have conditions where sedation is riskier (e.g., sleep apnoea), and have I discussed this with the team?
- Do I have a reliable escort and a quiet plan for the rest of the day?
There’s no prize for going without, and no pressure to take it if you don’t need it. The “right” choice is the one that gives you a smooth, safe, and positive experience.
Frequently asked questions
1) What anxiety medication is most commonly given before cataract surgery?
The most common options are mild benzodiazepines such as temazepam, diazepam, or lorazepam, usually taken as a tablet before surgery. Some clinics also use very small doses of intravenous midazolam during the procedure. These medicines are chosen because they act quickly, calm anxious feelings, and wear off in time for you to go home the same day.
2) Will I definitely be given medication to calm me down?
Not always. Many patients cope very well with just local anaesthetic and the support of a friendly team, so medication isn’t routinely given. If you’re feeling nervous, you can mention this during your pre-assessment or on the day, and your team will decide whether a small sedative would be helpful for you.
3) Can I choose which type of sedative I receive?
You can share your preferences, but the final decision rests with your surgical team who will match the safest option to your health profile. Some medicines are more suitable for certain patients than others, and your anaesthetist will balance effectiveness with safety to choose the best one for your circumstances.
4) How will I feel if I take an anxiety tablet before surgery?
Most people feel calmer, more relaxed, and less focused on their worries. You may feel slightly drowsy, but you’ll still be aware of what’s happening and able to respond to simple instructions. With intravenous midazolam, it’s also common to remember little of the procedure itself, which many patients find reassuring.
5) Are there risks linked to taking sedatives for cataract surgery?
Like any medication, sedatives carry small risks, such as drowsiness, slower reactions, or a short dip in breathing if the dose is too strong. That’s why only low doses are used and your oxygen, pulse, and blood pressure are carefully monitored. Serious complications are very rare when these medicines are given in this controlled way.
6) Will I need someone with me after having sedation?
Yes, you must have a responsible adult to take you home and stay with you for at least 24 hours if you’ve been given sedation. This is because you may still feel drowsy or less alert for the rest of the day. You won’t be able to drive, operate machinery, or make important decisions until the following day.
7) I have sleep apnoea—can I still take medication to calm me down?
Yes, but with extra caution. Sedatives can make sleep apnoea worse, so your anaesthetist will use the lowest possible dose and monitor you closely throughout the procedure. Always let your team know if you use a CPAP machine or have a history of breathing pauses so they can plan your care safely.
8) What happens if I’m extremely anxious or claustrophobic?
If you’re very anxious, your team will work with you to find the right balance. Often, a mild sedative combined with careful explanation and reassurance is enough. In rare cases, if you really cannot tolerate the idea of being awake, a general anaesthetic might be considered, although this is not the usual approach for cataract surgery.
9) Will I need the same medication for my second eye?
That depends on your experience with the first surgery. Many patients find they don’t need any sedative for the second eye because they already know what to expect and feel more relaxed. However, if you found a small dose helpful the first time, you can request the same again for your second procedure.
10) Can I take my own prescribed anxiety medication on the day of surgery?
You should never take your own anxiety medication before surgery unless your surgical team has specifically advised it. Some medicines can interact with the anaesthetic or affect your safety during the procedure. Always bring a full list of your current prescriptions to your pre-assessment so your clinicians can guide you on exactly what to take.
A quick checklist for discussing sedation with your team
- Tell them how you usually react to medical procedures.
- Share your full medication list and any allergies.
- Mention sleep apnoea, heart or lung conditions, or previous issues with sedation.
- Ask what they typically offer, and whether a small tablet or tiny IV dose might suit you.
- Confirm escort and travel plans home.
- Clarify when you can drive again and when it’s safe to make important decisions.
Final thoughts
Cataract surgery is designed to be one of the smoothest and most comfortable operations in modern medicine. For most people, good local anaesthetic and a calm, reassuring team are more than enough to get through the procedure without worry. If you know you’re likely to feel very anxious, or you simply prefer the idea of extra support, mild sedatives such as temazepam, diazepam, lorazepam, or a tiny IV dose of midazolam can be safely offered. The emphasis is always on keeping things light—helping you feel calm while still allowing you to recover quickly and go home the same day.
If you’re preparing for surgery, the most important step is to be open with your team about how you feel. That way, they can recommend the right approach for you, whether that’s reassurance alone, a small dose of medication, or extra adjustments to make you more comfortable. The aim is simple: a safe, smooth, and positive experience that leaves you wondering why you ever worried in the first place.
If you’d like to talk through your options in more detail, you can book a consultation with us at the London Cataract Centre and speak directly with our team. Taking that first step could bring you closer to clearer vision and a more confident outlook on life.
References
- Habib, N. E., Mandour, N. M. & Balmer, H. G. R., 2004. Effect of midazolam on anxiety level and pain perception in cataract surgery with topical anesthesia. Journal of Cataract & Refractive Surgery, 30(2), pp.437–443. DOI:10.1016/S0886-3350(03)00557-1. Available at: https://pubmed.ncbi.nlm.nih.gov/15030838/
- Alhashemi, J. A., 2006. Dexmedetomidine vs midazolam for monitored anaesthesia care during cataract surgery. British Journal of Anaesthesia, 96(6), pp.722–726. DOI:10.1093/bja/ael080. Available at: https://pubmed.ncbi.nlm.nih.gov/16595611/
- Obuchowska, I. & Konopińska, J., 2021. Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: a Systematic Review. Patient Related Outcome Measures, 14, pp.781–793. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219311/
- Chen, M., Hill, G. M., Patrianakos, T. D., Ku, E. S. & Chen, M. L., 2015. Oral diazepam versus intravenous midazolam for conscious sedation during cataract surgery performed using topical anesthesia. Journal of Cataract & Refractive Surgery, 41(2), pp.415–421. DOI:10.1016/j.jcrs.2014.06.027. Available at: https://pubmed.ncbi.nlm.nih.gov/25661136/
- Ramirez, D. A. et al., 2017. Anxiety in patients undergoing cataract surgery: a pre- and postoperative study. Clinical Ophthalmology, 11, pp.1935–1944. Available at: https://www.dovepress.com/anxiety-in-patients-undergoing-cataract-surgery-a-pre–and-postoperati-peer-reviewed-fulltext-article-OPTH