What Medications Are Given During Cataract Surgery?

Cataract surgery is famously quick and, for most people, surprisingly comfortable. What’s less visible is the careful choreography of medicines before, during and after the operation that keeps your eye safe, quiet and pain-free while it heals. If you’re preparing for surgery, understanding these drugs—what they are, why they’re used and how they may feel—can make the whole experience less mysterious and a lot more reassuring. In this guide, I’ll walk you through the typical medicines patients encounter on the day, explain how your team tailors choices to your health, and share practical tips so you know exactly what to expect.

Why medications matter in cataract surgery

At first glance, cataract surgery looks like a purely mechanical task: a tiny incision, ultrasound to soften and remove the cloudy lens, and a crystal-clear artificial lens (IOL) slipped into place. But the success of that five-to-fifteen-minute sequence rests on pharmacology. Medicines help to dilate the pupil, numb the surface, calm the eye’s internal nerves, keep the iris stable, prevent bacterial contamination, reduce inflammation, control eye pressure, and keep you relaxed. The doses are tiny, the timing is precise, and every choice is designed to minimise risk while maximising comfort and visual results.

Think of the medications as the backstage crew at a theatre production. You don’t see them directly, but nothing runs smoothly without their work. When people say the procedure felt “easy”, it’s usually because the medicines did their job.

The big picture: a simple timeline of the drugs you may receive

Before we look at each medicine in detail, it helps to picture where they fit into the day:

1. Pre-assessment and the days before surgery: sometimes anti-inflammatory drops (an NSAID) are started to prime the eye. You may be asked to continue your usual medicines, with specific advice about blood thinners or diabetes medication depending on local protocols.
2. On arrival to the surgical centre: antiseptic preparation (povidone-iodine) and dilating drops (tropicamide and/or phenylephrine). Some units also use an NSAID drop before theatre to help maintain dilation and reduce post-op inflammation. If you’re anxious, you may be offered a small dose of a short-acting sedative.
3. In theatre: topical anaesthetic drops or gel; sometimes a small amount of preservative-free lidocaine inside the eye; viscoelastic (not a drug, but a protective gel); intracameral antibiotic near the end of the case; sometimes agents to stabilise the iris or reduce internal inflammation.
4. Immediately after surgery and the first few weeks: antibiotic drops for a short course (depending on local policy) and a tapering anti-inflammatory regimen (usually a steroid, sometimes combined with an NSAID).

That’s the outline. Now, let’s unpack the classes one by one so you can recognise the names and understand why they’re used.

Antiseptic preparation: the single most important step you’ll never feel

Long before any incision, your team will clean the eyelashes and the ocular surface with povidone-iodine, an iodine-based antiseptic. This isn’t strictly an “antibiotic”, but it’s the most powerful, evidence-backed way to reduce bacterial counts on the eye and eyelids. It dramatically lowers the already small risk of endophthalmitis (a severe, sight-threatening infection). You might notice a mild stinging and a brownish tint around the eye for a moment, but that passes quickly. If you have an iodine or shellfish allergy, do mention it—modern practice can usually still proceed safely, but your team will choose the right prep and monitor you closely.

Dilating and iris-stabilising medicines: keeping the view wide and steady

Your surgeon needs a wide, stable pupil to work safely. That’s achieved with mydriatic drops instilled on the ward before theatre:

• Tropicamide relaxes the pupil’s constrictor muscle so the pupil opens.
• Phenylephrine stimulates the dilator muscle to enhance dilation.

You’ll likely notice brighter lights feeling a bit dazzling for a few hours—bring sunglasses for the journey home. Some centres add an NSAID drop around this time; it doesn’t dilate directly but helps prevent the pupil from “coming down” during surgery by damping inflammatory signals.

If you’ve ever taken tamsulosin (for prostate symptoms) or similar alpha-1 blockers, tell your team. These medicines can cause intraoperative floppy iris syndrome (IFIS), where the iris billows and constricts unpredictably. Surgeons manage this with a combination of strategies: a different dilating plan, gentle fluidics, viscoelastic that supports the iris, micro-devices (like pupil expansion rings), and sometimes intracameral phenylephrine to firm the iris. With the right preparation, IFIS becomes a manageable, rather than worrying, issue.

Anaesthesia and comfort: numbing the eye, calming the nerves

Most modern cataract operations are done with topical anaesthesia—numbing the surface of the eye—so you don’t feel pain but remain awake and able to follow simple instructions. You might be offered:

• Topical anaesthetic drops such as proxymetacaine or oxybuprocaine. These work within seconds and last long enough for the procedure. A lidocaine gel may follow for a cushioned, longer effect.
• Intracameral lidocaine (preservative-free): a tiny amount placed inside the eye at the start can quieten the iris and internal structures, reducing any dull ache or light sensitivity during the early steps.

If you’re very anxious—or if there are specific clinical reasons—your anaesthetist may suggest:

• Mild IV sedation, typically a very small dose of midazolam (to relax) and sometimes an opioid like fentanyl (to blunt any brief pressure sensation).
• Regional blocks (sub-Tenon’s or peribulbar) in selected cases: a local anaesthetic is placed around the eye to numb sensation and reduce eye movement. This is common if the case is predicted to be longer or if you strongly prefer not to feel anything at all.
• General anaesthesia is rare for routine cataracts but can be used for certain medical needs or in patients who cannot lie flat or keep still comfortably.

It’s worth saying: feeling gentle pressure, cool fluid, or a soft touch around the eyelids is normal, but you should not feel sharp pain. If you do, speak up—your team can top up the anaesthetic quickly.

Antibiotics: preventing infection from the inside out

While antisepsis is the cornerstone, most UK centres also use an intracameral antibiotic—a tiny dose placed into the front of the eye at the end of surgery—to further reduce endophthalmitis risk. The most common choices are:

• Cefuroxime, widely used and well studied.
• Moxifloxacin, often chosen if there’s a serious penicillin/cephalosporin allergy or based on surgeon preference and availability.

Because the dose is tiny and delivered exactly where it’s needed, systemic side-effects are very uncommon. You may still be prescribed topical antibiotic drops for a short course after surgery (practices vary by centre). If you’ve ever had a drug reaction, bring it up at pre-assessment—your plan can be tailored.

Anti-inflammatory medicines: quieting the eye’s natural response

Any surgery triggers inflammation, and the eye is no exception. You’ll typically use one or both of these after surgery:

• Topical corticosteroids (e.g., prednisolone acetate or dexamethasone) reduce swelling and quell the cells that drive inflammation. They usually start at a higher frequency and taper over a few weeks.
• Topical NSAIDs (e.g., ketorolac, bromfenac, nepafenac, diclofenac) target prostaglandins, complementing steroids and helping to reduce the risk of cystoid macular oedema (CMO).

If you’re a glaucoma patient or have a history of uveitis or diabetes, your anti-inflammatory plan may be longer or more intensive. If you’re steroid-responsive (your pressure tends to rise on steroid drops), your follow-up schedule will include pressure checks and your taper may be quicker or paired with pressure-lowering drops as needed.

Pressure-lowering agents: smoothing the early post-op hours

A transient rise in eye pressure can happen in the first day or two. Most people don’t notice it, but if you’re at risk—or if the pressure ticks up at review—you may receive:

• Acetazolamide (tablets), which reduces fluid production inside the eye.
• Topical pressure-lowering drops such as beta-blockers, alpha-agonists, or carbonic anhydrase inhibitors.

These are usually short-term. If you already use glaucoma drops, you’ll get clear instructions about continuing them straight through surgery unless told otherwise.

Agents used within the eye: small helpers you may never hear about

Some helpful medicines work silently inside the eye during the operation:

• Intracameral phenylephrine can help keep the iris stable and the pupil wide in challenging situations.
• Viscoelastic gels (not a medicine, but worth mentioning) protect the corneal endothelium and create space for manoeuvres. These are meticulously removed at the end to reduce the chance of a pressure rise.

You won’t feel these, and they’re part of standard microscopic micro-dosing that makes modern surgery safe.

Sedation and comfort medicines: keeping you relaxed but present

Most people do well with no sedation at all, but if you’re tense or claustrophobic, a whisper of midazolam can make a world of difference. The aim is “I feel fine,” not “I don’t remember anything.” You’ll breathe for yourself, you can respond to gentle instructions, and you’ll be back in recovery within minutes. Some centres also give an anti-sickness tablet if you’re prone to nausea.

If you prefer to avoid sedation entirely, say so—there’s no obligation. Equally, if you’d feel better with it, let the team know early so it’s planned into your pathway.

What you’ll likely take home

When you leave, you can expect a simple drop plan and clear written instructions. A common regimen looks like this (yours may differ):

• Antibiotic drops: 4 times a day for one week.
• Steroid drops: 4 times a day for 1–2 weeks, then taper to twice daily for a further 1–2 weeks.
• NSAID drops: once or twice daily for 3–4 weeks.

You’ll also receive advice on spacing drops, hand hygiene, and what to do if your eye suddenly gets very sore, red, or vision worsens.

Special situations your team plans for

You take blood thinners. Most cataract surgery uses tiny incisions and doesn’t require stopping anticoagulants, but your surgeon and anaesthetist will confirm a plan. Bruising around the eye is more likely with certain regional blocks than with purely topical anaesthesia, so the chosen technique may reflect this.

You have severe dry eye or blepharitis. Expect more attention to lid hygiene beforehand, preservative-free drops where possible, and careful surface lubrication during surgery. Pre-treating the lids can improve your day-one comfort and vision.

You have diabetes. Your anti-inflammatory plan may be longer to reduce CMO risk, and your review schedule may include a macular scan. Your usual diabetes medications will be managed around fasting and theatre times—this will be spelled out at pre-assessment.

You’ve had previous eye surgery. Prior corneal grafts, glaucoma surgery, vitrectomy, or high myopia can influence intraoperative agents and post-op anti-inflammatory duration. Trust that your notes are read carefully and the plan reflects them.

You are allergic to certain drugs. Alternatives exist for almost every step. Be specific about past reactions so the team can separate true allergy from intolerance.

Side-effects to know about (and what to do)

Most drops are very well tolerated. Here’s what you might notice and how to respond:

• Stinging on instillation is common and usually eases quickly.
• Light sensitivity and glare are common on day one due to dilation.
• Mild eyelid redness or itch can be managed with cool compresses.
• Pressure rise from steroids is unusual in the short term, but if you develop brow ache or halos, mention it.
• A rash or significant swelling is rare—stop the suspected drop and call the clinic.

If something feels “not right”, ask. It’s always safer to check.

What about “dropless” cataract surgery?

You may hear about approaches that use intraoperative sustained-release steroid or combine intracameral antibiotic with a depot anti-inflammatory to reduce or even eliminate post-op drops. These methods are evolving and can be very convenient for people who struggle with drops. Not every centre adopts them and not every eye is a good candidate, but it’s worth asking your surgeon whether there’s a drop-simplified pathway that suits your circumstances.

How your team tailors the medication plan to you

Tailoring is the norm in modern cataract care. Expect your plan to reflect:

• Your medical history.
• Your current medicines.
• Your eye’s anatomy.
• Your preferences.

Don’t be shy about your preferences—good teams want to accommodate them.

Practical tips for the smoothest medication experience

• Bring a current medicines list to pre-assessment.
• Ask about brand vs. generic.
• Practise drop technique before the day.
• Space out your bottles.
• Use a chart or phone reminder.
• Keep sunglasses handy for the ride home.

Myths to let go of

• “If I’m awake, I’ll feel everything.”
• “Antibiotic drops alone prevent infection.”
• “Steroids are dangerous.”
• “If I’m on blood thinners, I can’t have cataract surgery.”

Bringing it all together

The “medication bundle” around cataract surgery is deliberately simple for you to follow but sophisticated behind the scenes. Broadly, you’ll meet antiseptic prep, dilating drops, numbing drops or gel, maybe a touch of sedative, an intracameral antibiotic, and a short course of anti-inflammatory drops. If you have specific risks, you’ll also see pressure-lowering drops or tailored anti-inflammatory plans. Each piece exists for a clear reason and contributes to that satisfying day-one moment when the world looks brighter and crisper.

Frequently asked questions

1) Will I be awake during cataract surgery, and will it hurt?
Yes, most cataract surgeries are performed while you are awake. Anaesthetic drops or gel numb the surface of your eye so you don’t feel sharp pain. You may notice pressure, cool liquid moving across the eye, or see bright lights from the microscope, but these sensations are usually mild. If you feel very anxious, you may be offered a small amount of sedation to help you relax while still being able to respond to instructions. In rare cases, a local anaesthetic injection or even general anaesthesia can be used if necessary.

2) What if I’m allergic to penicillin or antibiotics?
A penicillin allergy will not prevent you from having cataract surgery. The antibiotic most commonly used at the end of surgery is cefuroxime, which is not a penicillin but belongs to the cephalosporin group. If you have a confirmed allergy to cephalosporins, your surgeon may use an alternative such as moxifloxacin. These medicines are placed directly into the eye in tiny amounts, making systemic reactions extremely rare. The key is to give your care team a full description of any previous allergic reaction so they can safely adapt your treatment.

3) I take tamsulosin for prostate problems—will that affect the operation?
Yes, tamsulosin and related medicines can make the iris more floppy during surgery, a condition known as intraoperative floppy iris syndrome (IFIS). This can make the pupil narrower or unstable, which would make the operation trickier without preparation. Surgeons are very familiar with IFIS and manage it by using stabilising gels, special dilating medicines, or small devices that hold the pupil open. With these measures, cataract surgery remains safe, and your vision outcome is not usually affected.

4) Do I need to stop blood thinners like warfarin or apixaban before surgery?
In most cases you can continue taking your blood thinners. Cataract surgery is performed through very small incisions, so the risk of significant bleeding is minimal. Stopping anticoagulants can increase the risk of blood clots, which is usually a greater danger than a small bruise around the eye. If you are taking strong anticoagulants or dual antiplatelet therapy, your surgeon and anaesthetist may make small adjustments to the anaesthetic technique rather than stopping your medication. Always follow the advice given at your pre-assessment.

5) How long will I need to use eye drops afterwards?
Typically, you’ll be prescribed antibiotic drops for around a week and anti-inflammatory drops for three to four weeks. Steroid drops are often tapered gradually, starting with frequent doses and then reducing as the eye heals. In some cases—such as patients with diabetes or uveitis—the course may be longer to protect the retina from swelling. You’ll receive clear written instructions about how often to use the drops, how to taper them, and when to stop.

6) What side-effects might I notice from the drops?
Mild stinging or burning when the drops are instilled is very common and usually fades within a minute. Some patients notice a temporary bitter taste in the mouth after putting drops in—this is harmless and can be reduced by pressing gently on the corner of the eye near the nose. Redness, dryness, or mild itching can also occur, especially if the drops contain preservatives. More serious side-effects such as swelling, spreading redness, or a sudden fall in vision are rare, but they should be reported immediately to the clinic so they can be checked.

7) Are there drop-free or “dropless” cataract surgery options?
Yes, some centres now use dropless approaches, where the antibiotic and anti-inflammatory medicines are placed inside the eye during surgery in a slow-release form. This can reduce or remove the need for you to use drops afterwards, which is especially useful if you struggle with arthritis, tremor, or poor vision in your other eye. However, dropless surgery is not suitable for everyone—for example, if you are at higher risk of retinal swelling or have a complex medical history, standard drops may still be preferred. It’s worth asking your surgeon if this option is available to you.

8) I have glaucoma—will cataract surgery affect my eye pressure?
In the first day or two, it is common for the pressure inside the eye to rise slightly. Your surgeon may prescribe tablets or drops to control this, especially if you already have glaucoma. In the longer term, cataract surgery can sometimes lower pressure by opening up the drainage channels inside the eye, which can be a bonus for people with glaucoma. However, it is not a replacement for glaucoma treatment—you will still need to continue your prescribed drops or procedures as advised by your eye specialist.

9) Can the medicines used affect other health conditions like diabetes?
The eye drops used during and after cataract surgery act locally, so they don’t usually affect other medical conditions. For people with diabetes, the main concern is protecting the retina from swelling (cystoid macular oedema). To reduce this risk, you may be prescribed anti-inflammatory drops for a longer period or have an extra retinal scan after surgery. If you have heart, lung, or kidney conditions, your anaesthetist will also choose sedation medicines carefully to avoid any complications.

10) What if I can’t manage putting drops in on my own?
This is a very common concern, especially for patients with arthritis, hand tremors, or poor eyesight. There are several solutions: you can use a drop-aid device that makes it easier to squeeze the bottle, you can arrange help from a family member or friend, or you may be referred to a community nurse. In some cases, a simplified or dropless treatment pathway can be offered. The most important thing is to mention any difficulty before surgery so that support can be arranged in advance.

Final thoughts

Cataract surgery is one of the safest and most effective procedures in modern medicine, and the role of medications is central to that success. From the numbing drops that keep you comfortable to the antibiotics and anti-inflammatory treatments that protect your vision afterwards, each medicine is carefully chosen and timed to give you the best possible result. Understanding what these drugs do helps take away much of the mystery and makes the day itself far less daunting.

It’s important to remember that your medication plan isn’t one-size-fits-all. Factors such as your general health, the medicines you already take, and the specific needs of your eyes will all shape the choices your surgical team makes. This tailored approach is what allows cataract surgery to work so smoothly for so many different people, even when medical histories are complex.

If you’re feeling unsure about any part of the process—whether it’s anaesthesia, drops, or potential side-effects—the best step is to raise your questions at your consultation. Nothing is too small to ask, and the answers will give you confidence in your treatment journey.

If you’re considering surgery and want to explore your options further, you can book a consultation with us at the London Cataract Centre and speak directly with our team. We’ll explain everything in detail, including your personalised medication plan, so that you can feel fully prepared. Taking that first step could bring you closer to clearer, brighter vision and the confidence that comes with it.

References

1. Barreau, G., Mounier, M., Marin, B., Adenis, J.P. & Robert, P.Y., 2012. Intracameral cefuroxime injection at the end of cataract surgery to reduce the incidence of endophthalmitis. Journal of Cataract & Refractive Surgery, 38(8), pp.1370-1375. Available at: https://pubmed.ncbi.nlm.nih.gov/22814043/ [Accessed 29 September 2025].
2. Passaro, M.L., Posarelli, M., Avolio, F.C., Ferrara, M., Costagliola, C., Semeraro, F. & Virgili, G., 2025. Evaluating the efficacy of postoperative topical antibiotics in cataract surgery: a systematic review and meta-analysis. Acta Ophthalmologica, 103(6), pp.622-633. Available at: https://pubmed.ncbi.nlm.nih.gov/40018950/ [Accessed 29 September 2025].
3. Kumar, C.M., 2019. Peri-operative considerations for sedation-analgesia during ophthalmic surgery, including cataract operations. Anaesthesia, 74(10), pp.1273-1283. Available at: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14845 [Accessed 29 September 2025].
4. Montan, P.G., Wejde, G., Koranyi, G. & Rylander, M., 2002. Prophylactic intracameral cefuroxime: efficacy in preventing endophthalmitis after cataract surgery. Journal of Cataract & Refractive Surgery, 28(6), pp.977-981. Available at: https://pubmed.ncbi.nlm.nih.gov/12036639/ [Accessed 29 September 2025].
5. Birtel, J., 2024. Dropless after cataract surgery (DACS) for patients with difficulty using drops: feasibility and outcomes. Eye. Available at: https://www.nature.com/articles/s41433-024-03055-8 [Accessed 29 September 2025].