COPD is a long-term lung condition that includes chronic bronchitis and emphysema. It causes airflow limitation, breathlessness, and sometimes low oxygen levels. If you’re living with COPD, you’re probably already aware of the extra precautions you take with infections, medications, and breathing support. But when it comes to eye surgery—especially something as common as cataract removal—you might not realise just how much your lung function can shape the planning process.
Although cataract surgery is typically brief and minimally invasive, it still involves lying flat under bright lights for 10 to 20 minutes, with potential use of local anaesthetics and mild sedatives. For someone with COPD, even this short duration can present risks. Poor oxygen exchange, carbon dioxide retention, and exacerbation of symptoms are all things your care team will be watching out for. That’s why pre-op assessment is so important—and often more thorough than for someone without a lung condition.
So if you’ve been told you need cataract surgery and you have COPD, don’t panic. With the right team and a personalised plan, the surgery can be done safely and successfully. Let’s break down what to expect.
Preoperative Assessment: Tailoring the Plan Around Your Lungs
Before cataract surgery, your ophthalmologist and anaesthetist will take a close look at your respiratory health. This usually starts with a detailed history—how often you get flare-ups, whether you use inhalers or home oxygen, and whether your COPD is stable. They might also ask about recent hospitalisations, exercise tolerance, and other related conditions such as sleep apnoea or heart disease.
In some cases, extra tests may be needed. A pulse oximeter reading will check your oxygen saturation. If you’re already borderline or dipping below 92%, they may ask for an arterial blood gas (ABG) test or a recent spirometry report from your respiratory team. These help determine how well your lungs are functioning and how you might cope during and after the procedure.
The goal here is simple: to avoid surprises on the day of surgery. If you’re using nebulisers or have had a recent flare-up, your surgery might be postponed until your lungs are more stable. This isn’t about being overly cautious—it’s about keeping you safe and avoiding unnecessary complications.
Oxygen Monitoring and Airway Support During Surgery
Unlike major surgeries, cataract operations are usually done under local anaesthetic, which is great news for people with COPD. It means you’re awake and breathing on your own the whole time—no need for general anaesthesia, intubation, or strong sedatives that can depress your respiratory drive.
However, the surgical team will still keep a close eye on your breathing. A small oxygen cannula may be placed in your nose, and your oxygen saturation will be continuously monitored throughout. If your levels drop, oxygen flow can be adjusted immediately.
Some patients with more severe COPD may be allowed to remain slightly upright rather than lying fully flat. This helps prevent shortness of breath and minimises the risk of oxygen desaturation. The surgical microscope can usually be adjusted to accommodate this slight recline.
Anaesthesia Options: Local, Topical, and What to Avoid
Most cataract surgeries are performed with topical anaesthesia (eye drops) or a local block (injection around the eye). These methods are safe and preferred in people with COPD because they avoid sedatives or anaesthetic agents that might impact your lungs.
That said, some patients feel anxious or uncomfortable lying still, so very mild sedation may be offered. The anaesthetist will choose something that’s fast-acting and easy to reverse. Agents like midazolam are used with caution and in low doses—especially in people with CO2 retention issues, where even a little respiratory depression could be problematic.
It’s essential that you share your full respiratory history and current medications, including inhalers and steroids. The anaesthetist will make adjustments based on this. If you’re on long-term steroids, you may also need a stress dose before surgery to avoid adrenal suppression.
Managing Medications Before and After Surgery
If you’re using inhalers or nebulisers, it’s important to continue them as prescribed right up to and after the procedure—unless your respiratory team advises otherwise. Missing a dose the morning of surgery can increase the risk of breathing difficulties, so make sure your surgical team is aware of what you’re on.
If you take steroids for COPD control, either orally or via inhalation, the surgical team may plan to give you a supplementary dose. This helps your body cope with surgical stress. You might also be advised to bring your inhalers with you on the day of the procedure.
Post-op, you’ll likely be prescribed antibiotic and anti-inflammatory eye drops. These don’t typically affect your lungs, but let your surgeon know if you have a known sensitivity to preservatives or certain ingredients, which can sometimes worsen respiratory symptoms.
Infection Risk and How to Stay Protected
COPD often makes people more susceptible to respiratory infections, and any surgery can slightly increase that risk—especially if you’re in a hospital setting. Cataract surgery is low-risk from an infection perspective, but it still pays to take precautions.
Wearing a mask (especially if it’s flu or COVID season), avoiding crowded waiting rooms, and ensuring that you’re well before the operation are all smart moves. If you develop a cough, fever, or shortness of breath in the days leading up to surgery, call the clinic. It’s better to reschedule than to go ahead while unwell.
If you’ve had frequent exacerbations or pneumonia in the past, let the team know. They might involve your respiratory consultant or primary care provider to develop a post-operative respiratory support plan—especially if you’ve needed antibiotics or steroids in similar past situations.
Breathing Easier with Supportive Positioning and Comfort Measures
Breathing comfortably during cataract surgery often comes down to how you’re positioned. Most people with COPD feel worse when lying completely flat, so don’t hesitate to speak up about your preferred angle or any discomfort.
The surgical team can use extra pillows, foam wedges, or even special surgical chairs to make things more comfortable. Remember, your eye is the only part of your body that needs to be still—not your whole self. As long as you’re not moving your head or eyes, small shifts in position are perfectly fine.
You may also benefit from having a calm, quiet environment. Bright lights, a busy operating room, or long waiting times can trigger anxiety and make breathing feel harder. Don’t be shy about asking for a quiet bay or minimal sedation if needed.
What Recovery Looks Like for COPD Patients
Recovery from cataract surgery is usually quick—even for people with COPD. You’ll go home the same day, and there’s no need to stop your usual respiratory medications. However, your breathing should still be monitored for a few hours post-op to ensure there are no signs of distress or oxygen desaturation.
Make sure your recovery space at home is well-ventilated and free from dust or strong chemical fumes, which can trigger respiratory symptoms. Arrange for someone to drive you home and help you settle in—especially if you’ve had a sedative or aren’t feeling 100% right away.
In the days after surgery, if you notice any increase in cough, sputum, breathlessness, or fever, contact your GP or surgical team. It could be an infection unrelated to your eye, but still needs prompt attention.
How Surgeons Minimise Risks for COPD Patients
Cataract surgeons are used to operating on people with all kinds of medical conditions, including chronic lung disease. The key to a successful outcome is multidisciplinary planning. That means your eye surgeon may liaise with your GP, respiratory team, or even a hospital anaesthetist to make sure everything is covered.
They may adjust your surgical time to early morning (when breathing tends to be better), provide more oxygen support, or avoid certain eye drops that contain preservatives. They may also space out your bilateral surgeries to avoid strain, and give you extra follow-up calls to check how you’re doing.
If you’re worried about any aspect of your breathing during or after surgery, speak up. Good communication can make a huge difference to how smooth the experience is.
Frequently Asked Questions
Can I still have cataract surgery if I have severe COPD?
Yes, even patients with severe COPD can safely undergo cataract surgery with proper preoperative planning and coordination. The key is ensuring that your COPD is stable at the time of surgery and that any recent flare-ups have been managed. Your care team may involve your respiratory consultant and will likely tailor your oxygen support, positioning, and anaesthesia approach to your lung condition. With these adjustments, the risks can be significantly reduced, making the procedure both safe and effective.
Will I need general anaesthesia for cataract surgery?
In almost all cases, general anaesthesia is avoided in people with COPD because it can suppress breathing and increase the risk of complications. Instead, surgeons use local anaesthetic techniques—either drops or a small injection near the eye—so you stay awake but don’t feel pain. This approach allows you to breathe normally and avoids the need for intubation or ventilators, which are riskier for people with lung disease. Only in extremely rare cases would general anaesthesia be considered, and only with input from your respiratory and anaesthetic teams.
Should I stop using my inhalers before surgery?
No, you should continue using your inhalers exactly as prescribed unless your doctor advises otherwise. In fact, using your bronchodilators on the morning of surgery helps to open up your airways and reduces the risk of breathing issues during the procedure. Make sure you bring your inhalers with you to the clinic, just in case you need them. If you’re using long-term steroid inhalers or oral steroids, your surgeon may also arrange a supplementary dose to help your body cope with the surgical stress.
What if I struggle to lie flat during the operation?
If you have difficulty lying flat due to breathlessness, your surgical team can adjust the bed to allow a slight incline, which often helps relieve that sensation. Most operating microscopes can be tilted accordingly, so the surgery can still be performed safely. Don’t hesitate to tell your surgeon or anaesthetist about your positional discomfort during your pre-operative consultation. These adjustments are common and can make the procedure much more comfortable for people with COPD.
Is it safe to take steroids if I’m having cataract surgery?
If you’re already on steroids for COPD, your medical team will take that into account when planning your surgery. Steroids are not contraindicated for cataract surgery, but long-term use can affect wound healing and immune response. Sometimes, an additional “stress dose” is given on the day of surgery to help prevent adrenal insufficiency. Your ophthalmologist and anaesthetist will work together to balance these concerns and ensure you’re protected without compromising your eye recovery.
Will I need oxygen during cataract surgery?
Many patients with COPD do receive low-flow supplemental oxygen during the procedure, especially if their oxygen saturation is borderline or drops while lying down. A small nasal cannula is typically used, and your oxygen levels will be continuously monitored throughout the surgery. The aim is to maintain adequate oxygenation without over-oxygenating, which can also be harmful in some advanced COPD cases. The anaesthetic team will carefully titrate the oxygen based on your needs.
Can cataract surgery worsen my COPD symptoms?
Cataract surgery itself does not directly worsen COPD, but the stress of any procedure—combined with exposure to hospital environments or changes in routine—can sometimes trigger an exacerbation. This is why it’s so important to have stable lungs going into surgery and to alert your team to any signs of worsening symptoms beforehand. After surgery, if you notice any increase in breathlessness, coughing, or sputum production, it’s essential to get checked promptly to rule out infection or flare-up.
How long will I need to stay in the clinic after surgery?
Most cataract surgeries are completed in under 30 minutes, and you’ll usually be monitored for a couple of hours afterwards. During this time, your oxygen levels, blood pressure, and comfort will be checked. If you’re stable and breathing well, you’ll be discharged the same day. However, if any breathing difficulty arises or if you’ve had sedation, your team may monitor you slightly longer. It’s a good idea to have someone accompany you home and stay with you for the rest of the day.
I use home oxygen—will that be a problem for surgery?
Using home oxygen doesn’t mean you can’t have cataract surgery, but it does mean the team will need to plan carefully. You should bring your oxygen prescription with you, and the anaesthetic team will ensure that oxygen is available throughout the procedure. Your respiratory team might be consulted in advance to check that your baseline oxygen levels are suitable for surgery. Post-operatively, you’ll resume your regular oxygen therapy, and adjustments can be made if needed based on how you feel.
Should I tell my surgeon about my COPD medications and history?
Yes—being open about your COPD history, medications, recent exacerbations, and hospital admissions is crucial. This allows your surgical team to tailor the procedure to your specific needs and avoid unnecessary risks. Let them know about any recent steroid use, infections, or if you’re on medications like theophylline or long-term antibiotics. The more your surgeon knows in advance, the safer and smoother your cataract surgery will be.
Final Thoughts: A Clearer Future Without Compromising Lung Health
Having chronic obstructive pulmonary disease (COPD) doesn’t mean you can’t safely have cataract surgery. With the right pre-op preparation, a considerate surgical team, and personalised anaesthetic planning, your lungs and your eyes can both be well cared for.
Clear vision can improve your quality of life, help you avoid falls, and allow you to better manage your medications and oxygen equipment. At London Cataract Centre, we understand the unique challenges COPD can bring and work closely with each patient to ensure a safe, comfortable surgical experience tailored to their respiratory needs.
If you’re living with COPD and considering cataract surgery, don’t hesitate to get in touch with us for a personalised consultation.
References
- Soler, N., DÃaz-Llopis, M., López-Artero, E., 2015. Corneal endothelial changes in patients with chronic obstructive pulmonary disease after cataract surgery. Journal of Cataract & Refractive Surgery, 41(4), pp.785–791. Available at: [abstract] https://www.sciencedirect.com/science/article/abs/pii/S0886335015000061
- Songur, M.S., İntepe, Y.S., Bayhan, S.A., Çiftçi, B., 2021. Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease. Clinical Respiratory Journal, 15(6), pp.604–610. Available at: https://doi.org/10.1111/crj.13347 (ResearchGate)
- Savran, O., Ulrik, C.S., 2023. Inhaled corticosteroid exposure and risk of cataract in patients with asthma and COPD: a systematic review and meta‑analysis. Journal of Ophthalmology, 2023:8209978. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602708
- Numata, T., Nakayama, K. et al., 2018. Risk factors of postoperative pulmonary complications in patients with asthma and COPD: a retrospective cohort study. BMC Pulmonary Medicine, 18:4. Available at: https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-017-0570-8
Medan, S., Ayoub, D. et al., 2023. Impact of cataract and COPD on health‑related quality of life: a longitudinal cohort study. BMJ Open Ophthalmology, 8:e000621. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234576