⚠️ What Can Go Wrong After Cataract Surgery?
Understanding the Possible Complications—and How to Protect Your Vision
By Dr. Edward Kondrot | All About Vision
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🧠 Story at a Glance
Cataract surgery is one of the safest and most common surgeries worldwide.
Still, as with any surgery, complications can happen—some minor, some more serious.
Common issues include posterior capsule opacification (PCO), inflammation, increased eye pressure, or infection.
Most complications are treatable, especially when identified early.
Understanding the risks can help you know what to watch for—and how to respond quickly.
👁️ The Good News First
Cataract surgery has a high success rate, with over 95% of patients experiencing improved vision afterward, according to the American Academy of Ophthalmology.
That said, it’s still surgery—and your eyes are delicate. So let’s walk through what might go wrong and what you can do about it.
🔍 Possible Cataract Surgery Complications
1. Posterior Capsule Opacification (PCO)
Sometimes called a "secondary cataract"
Happens when cells grow behind the lens implant, causing blurred vision
May appear weeks, months, or even years after surgery
Solution: Treated with a quick, painless laser procedure (YAG capsulotomy)
2. Infection (Endophthalmitis)
A rare but serious complication
Symptoms include pain, redness, vision loss, or discharge
Occurs in 0.04–0.2% of surgeries
Solution: Requires immediate treatment with antibiotics, sometimes surgery
3. Inflammation
Mild inflammation is normal, but sometimes it becomes persistent or excessive
May cause floaters, light sensitivity, or discomfort
Solution: Treated with anti-inflammatory eye drops or oral medications
4. Increased Eye Pressure (Ocular Hypertension or Glaucoma Flare)
Some patients experience a temporary or sustained rise in eye pressure
Temporary IOP spikes are common and often resolve. Persistent elevation may lead to glaucoma.
This may occur due to retained viscoelastic, steroid response, or preexisting glaucoma
Solution: Eye pressure-lowering drops or additional treatment and regular monitoring
5. Retinal Detachment
Very rare but more likely in patients who are highly nearsighted or have trauma history
Can occur weeks to months after surgery
Warning signs: Sudden floaters, light flashes, shadow or curtain in vision
Solution: Urgent retinal surgery
6. Cystoid Macular Edema (CME)
Swelling in the central retina (macula)
Can cause blurry or distorted central vision
Solution: Anti-inflammatory drops or injections, often temporary
7. Dislocated Intraocular Lens (IOL)
The artificial lens can shift out of place, especially in eyes with weak support structures
May cause double vision or severe blur
Solution: Surgical repositioning or replacement of the lens
8. Dry Eye or Surface Irritation
Can be worsened after surgery, especially in older patients or those with preexisting dry eye
Solution: Lubricating drops, omega-3s, or regenerative therapies
9. Ptosis (Drooping Eyelid)
Can occur after surgery due to instrument pressure on the eyelid
Usually resolves on its own
Solution: If persistent, minor surgical correction is available
10. Posterior Capsule Tear
The capsule behind the lens can tear during surgery, especially in complex cases.
This may increase the risk of lens dislocation, retinal detachment, or delayed inflammation.
Solution: Careful surgical management and sometimes a different lens implant technique.
11. Glaucoma Flare or Progression
Patients with preexisting glaucoma may see worsening after surgery.
Solution: IOP management, medication adjustments, and follow-up.
12. Iris Prolapse
Part of the iris can slip out of the surgical wound, usually due to wound instability.
Solution: Surgical repositioning and secure wound closure.
13. TASS (Toxic Anterior Segment Syndrome)
A sterile inflammatory reaction caused by contaminated surgical tools or solutions.
Rapid onset of pain, redness, and cloudy cornea.
Urgency: Immediate steroid treatment is essential.
14. Rebound Iritis (Chronic Inflammation)
Inflammation can return after tapering off steroid drops too soon.
Solution: Restarting anti-inflammatory therapy and slower tapering.
15. Photophobia (Light Sensitivity)
Often due to inflammation, dry eye, or lens edge effects.
Solution: Anti-inflammatory drops, blue light filters, or sunglasses.
16. Corneal Edema (Swelling)
The cornea may swell post-surgery, leading to blurry or hazy vision.
Usually temporary but may persist in those with weak corneal endothelial cells.
Solution: Hypertonic saline drops, anti-inflammatories, or corneal surgery if severe.
17. Dysphotopsia (Glare, Halos, Shadows)
Caused by lens edge reflections or implant position.
Positive dysphotopsia = halos or arcs; negative = dark shadows or blind spots.
Common in the early healing phase
Often improves with time, but can persist in some patients
May be more pronounced with multifocal IOLs
Solution: Time, managing light exposure, choosing different lens types if needed, lens exchange, or piggyback IOLs in rare cases.
18. Hyphema (Bleeding in the Eye)
Blood in the front chamber of the eye, often from iris trauma.
Solution: Elevate head, rest, and monitor. Rarely requires surgical drainage.
19. Persistent Eye Pain
Ongoing pain may signal dry eye, inflammation, nerve irritation, or more serious issues.
Solution: Full evaluation, tear support, or nerve pain treatment.
20. Inflammation (Uveitis)
Mild inflammation is expected—but prolonged or severe cases need attention.
Solution: Anti-inflammatory drops or oral meds based on severity.