Will I Be Awake During Cataract Surgery? What to Expect on the Day

If you’ve been told you need cataract surgery, one of the first questions that may pop into your head is, “Wait… will I be awake for this?” It’s a perfectly valid concern. Eye surgery can sound daunting enough without the added idea of being conscious throughout the whole thing. But here’s the good news: being awake during cataract surgery is completely normal, and the entire experience is designed to be as smooth and stress-free as possible.

In this article, we’ll walk you through everything that happens on the day of surgery, from the moment you arrive to what you’ll experience in the operating theatre. We’ll explain how the anaesthetic works, what the team does to keep you relaxed, and how you’ll feel both during and after the procedure. We’ll also answer some of the most common questions patients ask before surgery day.

Why You’ll Be Awake — and Why That’s a Good Thing

Yes, you’ll be awake during cataract surgery. That might sound unnerving at first, but there are some very good reasons for it. Cataract surgery is a short, highly controlled procedure that typically lasts around 10–15 minutes per eye. Because it’s minimally invasive and doesn’t require general anaesthesia, you can stay conscious and alert while still being completely comfortable.

Being awake allows your surgeon to communicate with you, guide your gaze if needed, and respond in real time to ensure the best possible outcome. It also significantly reduces the risks that come with being put under general anaesthesia — especially important for older adults or people with other medical conditions. Staying awake means faster recovery, fewer side effects, and getting home sooner.

The Role of Local Anaesthetic in Keeping You Comfortable

To make sure you don’t feel any pain during surgery, your eye will be numbed using a local anaesthetic. This is usually done with anaesthetic eye drops, although in some cases a small injection around the eye may be used for added numbing. Either way, the area becomes completely insensitive to pain.

The local anaesthetic works quickly and lasts long enough to cover the duration of the surgery. You might still feel some gentle pressure or a sense of movement, but there’s no pain involved. Some patients compare the sensation to having a contact lens placed on the eye — odd, but not uncomfortable.

What You’ll See During Surgery

One of the most common concerns patients raise is what they’ll actually see while the surgeon is operating on their eye. The good news is you won’t see instruments or anything graphic. Because of the bright surgical microscope light and the effects of the anaesthetic, your vision during the procedure will be a blur of lights and colours — often described as a soft kaleidoscope.

Most patients say they see vague shapes or brightness and that it feels more like looking through frosted glass than anything else. You won’t see the scalpel. You won’t see your lens being removed. And you won’t see the surgeon’s hands. In fact, many people are surprised by how little they remember visually.

Will I Blink or Move During the Procedure?

You may wonder how your eye can stay still or whether you might blink at the wrong time. But the surgical team has that covered. A small device called a speculum is gently placed to keep your eyelid open during the operation, so you don’t have to worry about blinking. You’ll also receive instructions to help you keep your gaze in a steady position, but even if your eye moves slightly, your surgeon is trained to adjust in real time.

Additionally, you’ll be given a mild sedative beforehand to help you relax. This ensures you’re calm and steady throughout the procedure, without feeling groggy or out of control. The team is used to working with nervous patients and will be talking to you during the operation to keep you reassured.

What You’ll Hear and Feel

While your vision is blurred and your eye is numbed, your hearing stays perfectly clear — and that can actually be comforting. You’ll hear the gentle hum of equipment, the voices of your surgical team, and soft instructions from your surgeon. Many patients say this made them feel more at ease, knowing exactly what was happening at each step.

As for what you’ll feel: you won’t experience pain, but you might be aware of a slight coolness from fluids, a faint tugging sensation, or a sense of pressure as the lens is removed and replaced. These sensations are normal and brief.

The Step-by-Step Experience on Surgery Day

Let’s walk you through what happens from start to finish:

1. Arrival: You’ll be asked to arrive early so the team can check your vital signs, confirm your details, and prepare you for surgery.
2. Anaesthetic and Drops: Numbing drops and dilating eye drops will be applied. A mild sedative may be given.
3. Positioning: You’ll be taken to the operating theatre and made comfortable on the reclining surgical bed.
4. Surgery Begins: The eye is cleaned, the speculum is placed to hold the eyelid open, and the surgeon begins the precise steps to remove the cataract.
5. Lens Implant: Once the cloudy lens is removed, a new artificial intraocular lens (IOL) is inserted.
6. Completion: The instruments are removed, your eye is protected with a shield, and you’re moved to recovery.

The whole process is efficient, precise, and remarkably calm.

After the Surgery: Still Awake, Still Okay

Once the surgery is complete, you’ll rest in a recovery area for a short while before being discharged the same day. Because you’ve stayed awake, you won’t need time to recover from general anaesthetic, so you’ll likely feel alert and clear-headed. You’ll be given post-op instructions, eye drops, and a follow-up appointment.

Some patients notice improved vision almost immediately, while for others it becomes clearer over a few days. Either way, you’ll be back on your feet quickly, usually with minimal discomfort.

FAQ: 10 Common Questions About Being Awake During Cataract Surgery

1. Is it scary to be awake during cataract surgery?
   It’s completely natural to feel a bit uneasy about being awake during eye surgery, but most patients are pleasantly surprised by how calm the experience actually is. You’re given a light sedative beforehand to help you relax, and your eye is numbed so there’s no pain. The surgical team will explain everything as it happens, so you’re never left in the dark. For many people, the procedure feels more like a routine medical appointment than anything dramatic.
2. Will I see the scalpel or instruments coming toward my eye?
   No, you won’t see any of the surgical tools used during the procedure. Your vision will be blurred by the microscope light and anaesthetic drops, making it impossible to make out sharp details. Most people report seeing soft shapes, vague colours, or shimmering lights — nothing that would cause distress. The brain tends to tune out the detail during this kind of procedure, so you’re unlikely to recall anything graphic.
3. What if I move my eye during surgery?
   You’re not expected to keep your eye completely still on your own — the surgical team is fully prepared for small, natural movements. Your head is gently supported, and your eyelids are held open with a soft clip called a speculum. The surgeon will guide your eye position using verbal cues, and if your gaze shifts slightly, it’s not a problem. The instruments are designed to be safe even with minor movements, and surgeons are very experienced in managing this.
4. Can I talk during the operation?
   Yes, you can speak if you need to, although it’s generally best to stay quiet unless there’s something urgent. If you’re feeling uncomfortable, anxious, or need clarification, don’t hesitate to say so — your surgical team will respond right away. Most patients find they don’t feel the need to talk much during the procedure, and instead find comfort in listening to the calm voices of the staff guiding them through it.
5. Will I remember everything that happens?
   You’ll likely remember bits and pieces — perhaps the brightness of the light, the voices of the team, or the sensation of fluid on your eye — but the entire experience often passes quickly. The mild sedative you’re given helps take the edge off and can make the memory of the procedure feel hazy. Many people say they remember less than they expected, and almost no one reports the experience as traumatic or frightening.
6. Does it feel like anything is happening to the eye?
   You won’t feel pain, but you may notice some mild sensations during the operation. These could include a sense of pressure, a coolness from the fluids used, or a gentle shifting feeling as the cataract is removed and the new lens is inserted. These sensations are completely normal and don’t last long. Because the anaesthetic is highly effective, most people describe the overall experience as odd but never painful.
7. How long will I be in the theatre?
   The actual surgical procedure typically takes about 10 to 15 minutes per eye, but the overall time in theatre might be slightly longer to allow for positioning and preparation. Including pre-op checks and post-op recovery, you’ll usually be at the clinic for a few hours in total. This makes it a very efficient process compared to procedures involving general anaesthesia or hospital admission.
8. Why don’t they just put people to sleep for it?
   General anaesthesia carries more risks, particularly for older patients or those with health conditions like heart disease or respiratory issues. Since cataract surgery is quick and not painful, local anaesthetic is both safer and more practical. Being awake also helps your surgeon guide the procedure more precisely. You avoid the grogginess and potential complications of general anaesthesia and can return home the same day without feeling ‘knocked out’.
9. What if I get anxious during the operation?
   Feeling anxious before or during surgery is completely normal, and the team is there to support you. You’ll be given a sedative to help you feel calm before entering the theatre, and if your anxiety rises mid-procedure, the surgeon can pause briefly and reassure you. Staff are used to helping nervous patients, and their experience in handling such situations makes a big difference. Often, just hearing a calm voice talking you through it can ease the nerves quickly.
10. Will I need someone with me after surgery?
    Yes, you’ll need someone to accompany you home after the procedure. Even though you’ll be awake and alert, the sedative can affect your coordination and concentration for several hours. You also won’t be able to drive, as your operated eye will be covered with a protective shield and your vision may be a little blurry initially. It’s a good idea to have someone stay with you for the rest of the day, just in case you need help getting settled or using your eye drops.

Final Thoughts

Being awake during cataract surgery might sound intimidating at first, but in reality, it’s a calm, controlled, and painless experience for the vast majority of patients. With local anaesthetic, gentle sedation, and a highly experienced surgical team guiding you through each step, you’re likely to find the procedure much easier than expected. From arrival to discharge, everything is designed to make you feel safe, relaxed, and informed.

At the London Cataract Centre, we know how important it is to feel confident going into surgery — especially if it’s your first time. That’s why we take the time to answer your questions, walk you through the process in detail, and provide support every step of the way. If you’re considering cataract surgery and want expert care in a comfortable, reassuring setting, we are here to help.

References

1. Ang, C.‑L., Au Eong, K. G., Lee, S. S. & Chan, S. P. (2007) ‘Patients’ expectation and experience of visual sensations during phacoemulsification under topical anaesthesia’, Eye 21(9), pp. 1162–1167. Available at: https://www.nature.com/articles/6702427
2. Wenzel, M., Sigmann, D. & Schulze Schwering, M. (2016) ‘Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview’, Eye (Lond) 30(3), pp. 385–391. Available at: https://www.nature.com/articles/eye2015239
3. Cureus Editorial (2024) ‘Phantom vision: a benign intraoperative visual experience in cataract surgery’, Cureus. Available at: https://www.cureus.com/articles/182344-phantom-vision‑a‑benign‑intraoperative‑visual‑experience‑in‑cataract‑surgery