What Kind of Anesthesia Do They Use for Eye Surgery?

October 9, 2025 •

5 min read

With nearly 10 million cataract surgeries performed worldwide each year, it's a common question for many patients: 'What kind of anesthesia do they use for eye surgery?'. The choice of anesthetic is highly individualized, depending on the specific procedure, patient health, and anxiety level.

Quick Summary

Several anesthesia methods exist for eye surgery, ranging from numbing eye drops for simple procedures to general anesthesia for complex cases. The choice depends on the surgery, patient age, health, and comfort. Many adults receive a combination of local numbing and mild sedation, staying awake but relaxed and pain-free.

Key Points

Variety of Anesthetics: The type of anesthesia for eye surgery depends on the procedure's complexity, the patient's age, overall health, and anxiety level.
Topical Anesthesia is Common: For many routine procedures, such as cataract surgery, numbing eye drops are the primary anesthetic, often supplemented with IV sedation for relaxation.
Sedation Provides Relaxation: Monitored Anesthesia Care (MAC) uses medications like midazolam and fentanyl via IV to help the patient feel relaxed and comfortable, and may cause them to forget the procedure.
Local Blocks for Deeper Numbing: For longer or more complex surgeries, an injectable local block (retrobulbar, peribulbar, or sub-Tenon's) is used to temporarily paralyze the eye muscles.
General Anesthesia is for Specific Cases: General anesthesia is reserved for patients who cannot remain still, such as children, or for very complex or lengthy surgeries.
Communication is Key: Discussing your anxieties, medical history, and the specifics of your procedure with your surgical team is essential for determining the safest and most comfortable anesthesia plan.

For anyone facing an ophthalmic procedure, understanding the options for pain control is a crucial step toward alleviating anxiety. The most common modern approaches involve a combination of localized numbing and intravenous (IV) sedation, allowing most patients to remain relaxed and comfortable without requiring a full general anesthetic. However, the best method is always determined in consultation with your surgical team and depends on the procedure and patient needs.

Types of Anesthesia for Eye Surgery

Topical Anesthesia

Topical anesthesia is the most common form of pain management for many straightforward procedures, particularly modern cataract surgery. It involves applying numbing eye drops, such as proparacaine, to the surface of the eye before and sometimes during the procedure.

Key features of topical anesthesia:

Administration: Eye drops are applied directly to the eye's surface.
Patient State: The patient remains awake and conscious throughout the surgery.
Eye Movement: The patient retains the ability to move their eye, requiring their cooperation to remain still and look at a target light during the procedure.
Supplementation: Often used in conjunction with monitored anesthesia care (MAC) via IV sedation to ensure relaxation and comfort. A supplemental intracameral injection of a local anesthetic, like lidocaine, may be added during the surgery for more profound numbing.

Local Anesthetic Blocks

For more complex or longer procedures, or for patients who cannot remain perfectly still, an injectable local anesthetic block is used to provide a deeper level of numbness and eye immobilization, or 'akinesia'. The injection is administered after the patient receives light IV sedation to ensure comfort.

There are several types of local blocks:

Retrobulbar Anesthesia: The anesthetic is injected into the retrobulbar space, which is the muscle cone behind the eyeball. This reliably provides sensory and motor blockade, temporarily paralyzing the extraocular muscles. This technique carries a slightly higher risk of complications due to the proximity of nerves and vessels.
Peribulbar Anesthesia: The anesthetic is injected into the space outside the muscle cone (peribulbar space). It typically requires a larger volume of anesthetic and may have a slower onset but carries a lower risk of serious orbital damage than a retrobulbar block.
Sub-Tenon's Anesthesia: A small incision is made in the conjunctiva to insert a blunt cannula, which then delivers the anesthetic into the space beneath Tenon's capsule. This technique is also very effective at numbing and paralyzing the eye with a lower risk of globe perforation compared to needle-based blocks.

Monitored Anesthesia Care (MAC) with Sedation

Monitored Anesthesia Care refers to the administration of sedatives and other pain-relieving medications intravenously by an anesthesiologist or nurse anesthetist. This is almost always used alongside topical anesthesia or a local block.

Commonly used medications for MAC include:

Benzodiazepines (e.g., midazolam/Versed): Provides anxiety reduction and amnesia, helping the patient relax and often not remember the procedure.
Opioids (e.g., fentanyl): Offer pain relief and work synergistically with sedatives.
Propofol: A fast-acting agent used for deeper sedation during administration of a local block or to maintain a state of calm.

General Anesthesia

General anesthesia causes a reversible, controlled state of unconsciousness, where the patient is completely unaware of the procedure. It is reserved for specific situations.

General anesthesia is typically used for:

Pediatric patients: Most children and infants require general anesthesia to ensure they remain completely still and safe throughout the surgery.
Complex or lengthy procedures: Vitreoretinal surgery or extensive reconstructive surgery may necessitate a motionless eye and prolonged operating time.
Patients unable to cooperate: Individuals with dementia, developmental issues, significant anxiety, or involuntary movements (e.g., nystagmus) may be better candidates for general anesthesia.
Major trauma or perforation: In cases of severe eye injuries, general anesthesia is indicated to protect the eye during surgery.

Comparison of Anesthesia Types for Eye Surgery


Feature	Topical Anesthesia	Local Anesthetic Block	MAC with Sedation	General Anesthesia
Administration	Eye drops	Injection near the eye	Intravenous (IV) line	IV line and/or inhaled gas
Consciousness	Patient is fully awake.	Patient is awake but sedated.	Patient is awake but relaxed or lightly sleeping.	Patient is unconscious and asleep.
Eye Movement	Eye can move, requires patient cooperation.	Eye is temporarily paralyzed (akinetic).	Eye movement depends on other techniques used.	Eye is completely still.
Procedure Length	Short, outpatient procedures (e.g., cataract surgery).	Longer, more complex procedures (e.g., some retinal surgeries).	Short to moderate procedures in tandem with local numbing.	Long, complex, or pediatric surgeries.
Recovery	Very fast recovery, often home within an hour.	Moderate recovery; numbness and blurry vision can last hours.	Fast recovery, but effects can last a couple of hours.	Slower recovery; potential for nausea and grogginess.
Risk Profile	Lowest risk, avoids complications of injection and sedation.	Low but with small risk of injection complications (e.g., bleeding).	Low risk, but requires careful monitoring by an anesthesiologist.	Highest risk, though still very low, involves effects on the whole body.

Factors Influencing the Choice of Anesthesia

The selection of the most suitable anesthesia for an eye procedure is a shared decision between the patient, the ophthalmologist, and the anesthesiologist. Key factors include:

Surgical Type and Duration: A straightforward cataract removal is very different from a complex vitreoretinal surgery. The latter, which is longer and more invasive, often requires a more profound block or even general anesthesia.
Patient Age: Most pediatric eye surgery requires general anesthesia because children cannot cooperate or remain still for the duration of the procedure.
Medical History: The patient's overall health is critical. Conditions like heart disease, pulmonary issues, or high myopia can influence the safety profile of different anesthesia types.
Patient Anxiety: For many patients, the thought of eye surgery can be stressful. The ability to cooperate and remain calm is paramount for procedures performed with local anesthesia. Sedation via MAC is used precisely to address patient anxiety and discomfort.
Surgeon and Anesthetist Preference: Some providers have a preference for certain techniques based on their training and experience. For example, some surgeons prefer avoiding IVs and using oral or sublingual sedatives.

Conclusion

In summary, the question of what kind of anesthesia do they use for eye surgery has a varied answer that is highly tailored to the individual and the procedure. For most common procedures like cataract surgery in adults, a combination of topical numbing drops and mild IV sedation (MAC) is standard, allowing for a quick, comfortable, and low-risk experience. More complex surgeries or those involving children typically necessitate a local block or general anesthesia to ensure complete stillness and a safe outcome. Open communication with your surgical team about your health, anxiety levels, and the specifics of your procedure will help determine the optimal anesthesia plan for your needs.

For more detailed information on specific techniques and agents, EyeWiki provides extensive resources on ocular anesthesia.

Frequently Asked Questions

For most routine adult eye surgeries, like cataract removal, you will be awake but relaxed with a combination of numbing eye drops and mild IV sedation. The goal is to keep you comfortable and calm while maintaining your ability to cooperate.

A local block is administered while you are lightly sedated, so you likely won't remember the injection. Once the block takes effect, the eye becomes completely numb, and you lose the ability to move it voluntarily. You may feel pressure but no pain during the procedure.

Side effects vary depending on the type. With local anesthesia, some temporary blurred vision or a numb eyelid can occur. Sedation can cause temporary grogginess or amnesia. General anesthesia has a higher risk of side effects like nausea or confusion during recovery, though serious complications are rare.

Topical numbing effects wear off relatively quickly. A local anesthetic block can cause numbness and temporary vision changes for several hours. Sedation effects can last a few hours, though patients often feel back to normal fairly quickly. General anesthesia requires a longer recovery period.

Children typically receive general anesthesia because they cannot be expected to remain still and cooperative during the procedure, which is critical for safe and precise eye surgery.

Yes, some centers offer IV-free sedation using oral or sublingual medications for anxious patients, but a dedicated anesthesiologist is still often involved to monitor the patient.

You will receive specific instructions, but general guidelines include avoiding food and drink for a certain period before surgery, especially if general anesthesia is used. Inform your doctor of all medications, including blood thinners, that you are taking.