What is the most common anesthetic used in cataract surgery?

October 10, 2025 •

4 min read

With over 10 million procedures performed globally each year, cataract surgery is one of the most common surgical interventions. For most patients, the most common anesthetic used in cataract surgery today is topical anesthesia, often paired with light intravenous (IV) sedation to ensure comfort and relaxation. This modern approach offers a safer, less invasive alternative to older techniques involving injectable blocks.

Quick Summary

The majority of cataract procedures use a combination of topical anesthetic drops, typically lidocaine, and light IV sedation to maximize patient comfort and cooperation.

Key Points

Topical anesthesia is most common: A combination of numbing eye drops, most frequently containing lidocaine, and light IV sedation is the standard for most modern cataract surgery.
IV Sedation provides relaxation: Medicated sedation, or 'twilight sleep', helps patients relax and feel comfortable during the procedure without being fully unconscious.
Injectable blocks are an option: Local injections around the eye are used for more complex cases or when full immobilization of the eye is required.
General anesthesia is rare: Being fully put to sleep is reserved for children, highly anxious patients, or those with conditions that prevent them from staying still.
Less invasive, less risk: The shift towards topical anesthesia has led to faster recovery and reduced risks associated with anesthetic injections.
Anesthetic choice is personalized: The selection of anesthetic depends on the individual patient's health, anxiety levels, and the complexity of the surgical case.

The Most Common Anesthetic Combination

The most prevalent method for anesthetizing a patient for cataract surgery is a combination of topical anesthesia and light intravenous (IV) sedation. This approach has become the standard of care due to its excellent safety profile, rapid recovery times, and superior patient comfort compared to more invasive methods used in the past. The entire process allows the patient to remain relaxed and pain-free while being awake and cooperative during the short procedure.

Topical Anesthesia with Lidocaine

The primary component of this anesthesia method is a topical anesthetic, most commonly lidocaine in the form of eye drops. The administration typically involves:

A series of numbing eye drops applied to the surface of the eye by a nurse in the pre-operative area.
An intraoperative step where the surgeon may inject a small amount of preservative-free lidocaine directly into the anterior chamber of the eye (intracameral injection) for additional numbing.
A gel form of topical anesthetic may also be used in some cases.

Topical anesthesia effectively desensitizes the cornea, where the surgical incisions are made, but allows the patient to retain the ability to move their eye. This is why patients are instructed to focus on the operating microscope's light during the procedure to help the surgeon.

IV Sedation

Alongside the topical anesthetic, most patients receive light IV sedation, also known as monitored anesthesia care (MAC) or "twilight sedation". An anesthetist or registered nurse administers relaxing medications through an IV line to calm any anxiety a patient may feel. Common medications include midazolam (Versed) and fentanyl. This combination works quickly and is easily adjusted to the patient's anxiety level, with many patients remembering little to nothing about the operation afterward.

Alternative Anesthetic Methods

While the topical/sedation combination is standard, alternative methods are used for specific patient populations or complex surgical cases.

Injectable Nerve Blocks

For more complex or longer procedures, or for patients who are unable to cooperate, a local anesthetic injection may be used. These blocks, such as retrobulbar, peribulbar, or sub-Tenon's blocks, involve injecting a numbing agent around or behind the eye. The benefits of a block include deeper, longer-lasting numbness and temporary paralysis of the eye muscles, which prevents involuntary eye movement. However, the technique is more invasive and carries a higher risk of complications, such as a retrobulbar hemorrhage or, very rarely, damage to the optic nerve.

General Anesthesia

General anesthesia, which puts a patient completely to sleep, is rarely necessary for routine cataract surgery but is an option in specific situations. These special circumstances include:

Pediatric patients
Patients with significant anxiety, claustrophobia, or other mental disabilities
Individuals with medical conditions like severe nystagmus (involuntary eye movements) or movement disorders that prevent them from lying still
Patients with allergies to local anesthetic agents

General anesthesia carries greater risks than local or topical anesthesia, particularly for patients with heart or lung conditions. Therefore, the benefits must outweigh the risks before it is considered.

Comparison of Anesthetic Options


Feature	Topical with IV Sedation	Local Injectable Block	General Anesthesia
Administration	Eye drops + IV line	Injection around the eye	IV line + mask/breathing tube
Invasiveness	Minimal (non-invasive drops)	More invasive (injection)	Highly invasive (full sedation)
Eye Movement	Patient must fixate on light	Eye muscles are temporarily paralyzed	No eye movement
Pain Control	Excellent, but may feel pressure	Excellent, deeper numbness	Complete lack of sensation
Recovery Time	Rapid (home in 30-60 mins)	Longer, numbness lasts for hours	Extended recovery due to full sedation
Primary Use	Routine, uncomplicated cases	Complex cases or uncooperative patients	Children, severe anxiety, specific medical conditions

Factors Influencing Anesthetic Choice

When a surgeon determines the best anesthetic plan, several factors are taken into account to maximize patient comfort and safety. The best choice is always a collaborative decision between the patient, surgeon, and anesthesia provider.

Patient Factors: A patient's anxiety level is a significant consideration. A patient with high anxiety may be more difficult to operate on under topical anesthesia alone, potentially increasing the risk of intraoperative complications. The ability to remain still and cooperative is also critical.

Surgical Factors: Complex or lengthy procedures, like cases involving a hard, dense cataract, may require a deeper level of anesthesia to ensure the patient remains comfortable and the procedure is performed without interruption. A surgeon's preference and experience also play a role in selecting a technique.

Medical Factors: Pre-existing medical conditions must be evaluated. Certain conditions, such as movement disorders, can make a patient an unsuitable candidate for topical anesthesia. Additionally, blood thinners and anticoagulant medication regimens may influence the choice of anesthetic to minimize the risk of bleeding complications associated with injectable blocks.

Conclusion: The Modern Preference

In modern ophthalmology, the dominant trend for routine cataract surgery is the use of topical anesthetic eye drops, typically containing lidocaine, combined with light IV sedation. This outpatient approach offers a comfortable, safe, and efficient experience with a rapid recovery. The anesthetic choice is always tailored to the individual, with injectable blocks and general anesthesia reserved for more complex cases or specific patient needs. This personalized approach to pain management ensures that cataract surgery, one of the most common surgical procedures globally, remains a safe and successful option for restoring vision. For more information, you may want to consult resources from the National Institutes of Health.

Frequently Asked Questions

In most cases, yes, you will be awake but very relaxed and sleepy due to the light intravenous sedation. Many patients have little to no recollection of the procedure afterward.

No, topical anesthetic eye drops numb the surface of the eye, effectively preventing you from feeling any pain during the procedure. You may, however, feel slight pressure or a touch sensation.

Intracameral anesthesia is when the surgeon injects a small amount of a numbing agent, such as lidocaine, directly inside the front chamber of the eye to provide supplemental numbness. This is often used in combination with topical drops.

With topical anesthesia, the numbness wears off relatively quickly, often within one to two hours after the surgery. If an injectable block was used, the numbness and lack of eye movement can last for several hours.

General anesthesia is used only in rare circumstances. It may be necessary for children, patients with severe anxiety, or individuals with medical conditions that prevent them from remaining still and cooperative during the procedure.

Topical anesthesia is preferred because it is non-invasive, has a lower risk of complications compared to injectable blocks, and allows for very quick recovery. Its effectiveness is enhanced with IV sedation for a comfortable patient experience.

Side effects are usually minimal with modern anesthesia. They can include temporary effects like blurred vision or temporary lack of eye movement with injectable blocks. More complex anesthesia, like general, carries a higher risk of side effects such as nausea or confusion.