If you’re living with G6PD deficiency and facing cataract surgery, you probably have a few extra questions on your mind. You already know that people with this condition need to avoid certain medicines because of the risk of haemolysis (red blood cells breaking down too quickly). So when it comes to surgery, especially something as delicate as cataract surgery, it makes sense to ask: which drops are safe? Which antibiotics should be avoided? And how does your eye surgeon make sure you’re fully protected?
This guide is here to walk you through everything. We’ll cover what G6PD deficiency means in the context of cataract surgery, what medications are safe, what to avoid, and how your surgical team works behind the scenes to make sure your operation is both smooth and safe. Think of this as a practical, reassuring conversation to help you feel informed before your big day.
What is G6PD Deficiency?
Glucose-6-phosphate dehydrogenase deficiency, often shortened to G6PD deficiency, is one of the most common enzyme deficiencies worldwide. It affects the way your red blood cells handle oxidative stress. Normally, G6PD acts as a protective shield, helping your blood cells cope with everyday exposure to oxygen by-products and certain chemicals. Without enough of it, some medicines, foods, or infections can tip the balance, leading to haemolysis.
Haemolysis is when red blood cells break apart faster than your body can replace them. Symptoms can include fatigue, jaundice, dark urine, and sometimes more serious complications. That’s why people with G6PD deficiency learn early on to avoid certain triggers — classic examples being sulfa drugs, some antibiotics, and even fava beans.
When it comes to cataract surgery, this enzyme deficiency doesn’t mean you can’t have the procedure. What it does mean is that your surgical team needs to be aware and careful about the medications they use. The good news? Modern cataract surgery already has many safe options available, so your operation can go ahead with very little fuss — once the right precautions are in place.
Why Cataract Surgery Needs Special Consideration
Cataract surgery is one of the most commonly performed operations worldwide. For most people, it’s straightforward, quick, and highly successful. But for someone with G6PD deficiency, there’s a slightly different angle: making sure none of the medicines used before, during, or after the operation will put your red blood cells at risk.
This matters because cataract surgery involves not just the removal of the cloudy lens, but also a short period of recovery where drops, antibiotics, and sometimes systemic medicines are used. While most of these are safe, a small handful can cause problems in G6PD-deficient patients. That’s why it’s so important to plan ahead and work with a team that knows how to adapt your care.
With the right preparation, your surgery isn’t any riskier than anyone else’s. The key is to avoid certain antibiotics (like sulfonamides and nitrofurantoin), make sure your drops are G6PD-safe, and have everyone on the surgical team aware of your condition.
Safe Eye Drops in G6PD Deficiency
Let’s start with the most common part of cataract surgery aftercare: eye drops. After the operation, you’ll almost certainly be prescribed a set of drops to help the eye heal and reduce the risk of infection or inflammation. For most people with G6PD deficiency, the following are considered safe:
- Steroid drops such as prednisolone acetate or dexamethasone. These help control inflammation and are widely used after cataract surgery. They don’t affect red blood cells in a way that’s dangerous for you.
- NSAID drops like diclofenac or ketorolac. These are also safe, and they’re often given to help reduce swelling and prevent certain post-operative complications.
- Fluoroquinolone antibiotic drops such as moxifloxacin or ofloxacin. These are commonly used to prevent infection after cataract surgery and are well tolerated in G6PD deficiency.
- Gentamicin drops, another antibiotic option, are also safe if prescribed.
What you’ll want to avoid are sulfonamide-based drops, which can trigger haemolysis. Thankfully, they’re rarely used in modern eye surgery, so this isn’t a common issue — but it’s worth being aware.
Safe Systemic Antibiotics (If Needed)
Most cataract operations don’t require oral or intravenous antibiotics. The majority of protection comes from antibiotic drops placed directly in the eye. But in rare cases — for example, if there’s a risk of infection spreading — systemic antibiotics may be prescribed.
The good news is that there are plenty of safe options for you. Penicillins, cephalosporins, macrolides (like erythromycin or azithromycin), and tetracyclines are all generally safe in G6PD deficiency. These drugs don’t usually pose a risk of haemolysis.
On the flip side, sulfonamides (like trimethoprim-sulfamethoxazole) and nitrofurantoin should be avoided. These are well-known triggers and can cause problems. But since they’re not standard choices for eye infections, your surgical team will usually have no difficulty steering clear of them.
Anaesthesia and G6PD Deficiency
Most cataract surgery is done under local anaesthesia, either with numbing drops or with a small injection around the eye. These local anaesthetics are safe for people with G6PD deficiency. General anaesthesia is rarely needed, but if it is, your anaesthetist will be mindful about drug choices.
Some older anaesthetic agents are thought to carry theoretical risks, but with modern practice, this is almost never an issue. The important thing is that your anaesthetist is told in advance so they can cross-check every medicine used.
How Your Surgical Team Prepares
Your surgeon won’t go into this blind. Before your operation, the team will:
- Review your medical history, paying special attention to your G6PD deficiency.
- Confirm any past medication reactions you’ve had.
- Double-check your current prescriptions to make sure nothing interferes.
- Choose only G6PD-safe eye drops and antibiotics.
- Plan follow-up visits to monitor both your eye healing and your overall health.
Sometimes they may also involve your GP or a haematologist, especially if you have a more complex health background. It’s all about building a safety net so nothing gets overlooked.
Recovery and Follow-Up
Once the cataract is removed and your new lens is in place, the focus shifts to recovery. For you, this stage looks very similar to anyone else’s, with the only real difference being the careful choice of drops and medicines.
You’ll be using your steroid and antibiotic drops regularly for the first few weeks. You’ll attend follow-up appointments where your surgeon checks your vision, your eye pressure, and the healing process. They’ll also be keeping an eye out for any signs of infection or unusual side effects.
As someone with G6PD deficiency, you should also be aware of symptoms of haemolysis — things like unusual tiredness, jaundice, or dark urine. These are very unlikely if your medications are carefully chosen, but it’s good to know what to watch for.
Living with Confidence
Having G6PD deficiency does not mean your cataract surgery will be more dangerous or less effective. It simply means that your care is slightly more tailored. Once the right precautions are in place, your experience should be smooth, and your results — clearer vision, less glare, more confidence in your eyesight — will be just as rewarding as for anyone else.
FAQ: Cataract Surgery with G6PD Deficiency
1. Can I still have cataract surgery if I have G6PD deficiency?
Yes, you absolutely can. Having G6PD deficiency doesn’t mean cataract surgery is off the table; it just means your care needs a little extra planning. The main point is to avoid unsafe medicines, such as sulfonamide antibiotics, and to choose alternatives that are known to be safe. Once your surgical team has tailored the medication plan, your surgery will be just as safe and effective as it is for people without G6PD deficiency.
2. Which eye drops are safe for me after surgery?
Most of the drops commonly used in cataract surgery are perfectly safe for you. These include steroid drops to control inflammation, NSAID drops to reduce swelling, and fluoroquinolone antibiotics such as moxifloxacin to prevent infection. Gentamicin is also safe if it’s prescribed. The only drops to avoid are those containing sulfonamides, but these are not usually part of modern cataract surgery aftercare.
3. Do I need special antibiotics after my operation?
In most cases, you won’t need oral antibiotics at all — the antibiotic eye drops used directly on the eye provide enough protection. However, if an oral antibiotic is required, your doctor will choose from safe options like penicillins, cephalosporins, macrolides, or tetracyclines. The key is to avoid sulfonamides and nitrofurantoin, as these are well-known triggers of haemolysis in people with G6PD deficiency.
4. Can the anaesthetic cause problems for me?
Anaesthesia for cataract surgery is usually very straightforward, and the local anaesthetic drops or small injections used are safe in G6PD deficiency. If a general anaesthetic is ever needed — which is rare — your anaesthetist will make sure that all drugs chosen are suitable for you. With modern anaesthesia, the risk of running into problems linked to G6PD deficiency is extremely low.
5. Should I tell my surgeon about my condition?
Yes, you should always make sure your surgical team knows about your G6PD deficiency. Even if you feel it’s already in your records, it’s worth reminding your surgeon, anaesthetist, and nurses. This way, everyone involved is fully aware and can double-check every medication that is prescribed. Clear communication is one of the simplest and most effective ways to make sure you stay safe.
6. What signs of haemolysis should I watch for after surgery?
Although rare after cataract surgery, it’s still useful to know the warning signs of haemolysis. These include tiredness, shortness of breath, jaundice (yellowing of the skin or eyes), and dark-coloured urine. If you notice any of these symptoms, you should seek medical advice immediately. Most people never experience this after surgery, but being aware puts you in control.
7. What if a doctor accidentally prescribes a sulfa antibiotic?
If this happens, the best step is to speak up right away. Politely remind your doctor or pharmacist that you have G6PD deficiency and cannot take sulfa-containing drugs. There are always safe alternatives that can be used instead. By making your condition clear, you prevent problems before they start, and your healthcare team will quickly switch to a safe option.
8. Does G6PD deficiency affect how quickly I heal?
No, it doesn’t. Your eye will heal from cataract surgery at the same rate as anyone else’s. The condition only affects which medicines you can safely take — not your body’s natural ability to recover. So as long as the correct drops and antibiotics are prescribed, your recovery time and outcome should be just as positive.
9. Can cataract surgery itself trigger haemolysis?
No, the surgery itself does not cause haemolysis. The only risk comes from certain unsafe medications, which is why the care team carefully avoids them. The surgical process, including the removal of the cataract and placement of the new lens, has no effect on your red blood cells. Once the right medicines are chosen, you can go into surgery without worrying about your G6PD deficiency being a direct problem.
10. How do I make sure I’m safe at every step?
The best way to stay safe is to be proactive. Always tell every member of your healthcare team about your G6PD deficiency, ask questions about your medications, and don’t be afraid to double-check anything you’re prescribed. Keeping a simple written note of medicines to avoid can also be handy to carry with you. By being clear and involved in your own care, you make sure nothing slips through the cracks.
Final Thoughts
Cataract surgery with G6PD deficiency is not only possible, but usually very straightforward when handled properly. The key is communication, preparation, and careful selection of medicines. With the right team on your side, you can have confidence that your operation will go ahead safely and deliver the clear vision you’ve been waiting for.
At the London Cataract Centre, we’re experienced in tailoring cataract surgery for people with different health needs, including G6PD deficiency. If you’d like to discuss your options in more detail, we’d be happy to guide you every step of the way.
References
- Cappellini, M.D. and Fiorelli, G. (2008) ‘Glucose-6-phosphate dehydrogenase deficiency’, The Lancet, 371(9606), pp. 64–74. doi:10.1016/S0140-6736(08)60073-2. Available at: https://doi.org/10.1016/S0140-6736(08)60073-2 (Accessed 21 August 2025).
- Luzzatto, L., Ally, M. and Notaro, R. (2020) ‘Glucose-6-phosphate dehydrogenase deficiency’, Blood, 136(11), pp. 1225–1240. doi:10.1182/blood.2019000944. Available at: https://doi.org/10.1182/blood.2019000944 (Accessed 21 August 2025).
- Youngster, I., Arcavi, L., Schechmaster, R., Akayzen, Y., Popliski, H., Shimonov, J., Beig, S., Berkovitch, M., Yehezkelli, Y. and Levy, A. (2010) ‘Medications and glucose-6-phosphate dehydrogenase deficiency: an evidence-based review’, Drug Safety, 33(9), pp. 713–726. doi:10.2165/11536520-000000000-00000. Available at: https://link.springer.com/article/10.2165/11536520-000000000-00000 (Accessed 21 August 2025).
- American Academy of Ophthalmology (2022) ‘Cataract in the Adult Eye Preferred Practice Pattern®’, Ophthalmology, 129(1), P1–P126. doi:10.1016/j.ophtha.2021.10.006. Available at: https://pubmed.ncbi.nlm.nih.gov/34780842/ (Accessed 21 August 2025).
- Barry, P., Cordovés, L. and Gardner, S. (2018, updated) ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery. Dublin: European Society of Cataract & Refractive Surgeons. Available at: https://www.escrs.org/media/uljgvpn1/english_2018_updated.pdf (Accessed 21 August 2025).