Pre and post op care of

cataract in mch, Thrissur

SUBMITTED TO SUBMITTED BY
DR. BINDU K NAIR ATHIRA PS
ASST. PROFESSOR 1ST YEAR MSc NURSING
GOVT. COLLEGE OF NURSING GOVT. COLLEGE OF NURSING
THRISSUR THRISSUR

The Routine Routine Postoperative Care: F/U visit schedule

Examination componentsMedication ScheduleEarly & late post-operative
complicationsManagement of complications
9 Post-op instructions The norm- May remain for 6-8 weeks
Blurry, fluctuating, shimmering visionMild discomfortDrops may stingDrops may leave
harmless white residue in the corner of the eyeEye may feel scratchy or dry- provide patients
with ATSlight rednessWateringMild irritationGlareSlight drooping
10 Post-op instructions The DOs:
Wash hands before and after using eye dropsWear your glasses during the day and wear the
eye shield at night x 7 daysUnless doctor instructions specify otherwiseWear sunglasses
when out x 1 week during daylightTo protect the eyes from sunlight & injuriesShake the
drops and use as instructedOnly use clean tissues to wipe the eyeMake sure eyelids are
always clean after surgeryUse warm compresses at least twice a dayUse OTC reading glasses
until Rx is finalized 4-6 weeks after surgeryIf any minimal pain use two Tylenol tablets for
reliefSevere pain should be reported to the doctor immediatelyReport to the doctor ASAP
if:Persistent pain- not relieved by TylenolRednessDischargeUnexpected loss of vision &/or
field visionFlashes or floaters
11 Post-op instructions The DONTs:
Activity: Normal activity except heavy labor or sports can be resumed immediatelyNo heavy
lifting (anything over 5 pounds) or bending (below waistline) x 1 weekNo driving the day of
or after surgeryAt 4 weeks all normal activities can resumeAvoid hard rubbing or squeezing
eye x 1 monthstraining, squeezing or a blow to eye can result in disastrous complicationsFace
wash: For the first few days, close your eyes when washing faceBathing:Avoid any water
splashing into the eye x 1 weekCan bathe with head tilted backwards or keep eyes closed
during showerGames:Avoid strenuous activities like jogging, lifting weights, swimming,
gardening, aerobics, contact sports x 2 weeksNormal daily activities including walking,
reading and watching TV may be resumed immediately following the surgeryMakeup: Avoid
eye makeup x 2 weeksDiet: No dietary restrictionsDriving: You should not begin driving
until indicated by your doctorJob: Can resume 2 days s/p surgeryTravel:Can travel 1 week
after surgeryKeep eyes well lubricated during flightAvoid aspirin
12 F/U Schedule 1 Day 1 week 1 month 3-6 month
*Case Hx: status since surgery? pain? dry? discomfort? sleep? sick? vision?*VA (s)*SLE:
Wound site (&sutures); K; AC; IOL condition & centration* IOPReview Postoperative
instructions1 week*Case Hx: status since surgery? pain? dry? discomfort? vision? review of
complaints & instructions*VA (s) + SLE + IOP*DFE: IOL centration & position; Posterior
capsule; macula; peripheral retina*AB drops usually stopped after this visit*Case Hx: status
since surgery? dry? discomfort? vision?*VA (s) + Refraction/Keratometry + SLE + IOP*Rx
released at this visit*Steroids & NSAIDs- almost done1 month3-6 monthComplete Eye Exam
13 Medication Schedule Week 1 P.O. Week 2 P.O. Week 3 P.O. P.O.
3 Days BeforeAntiBiotic QIDNSAID BID-QID**ATs PRNWeek 1 P.O.AntiBiotic QID x 1
weekNSAID QIDx 1 weekSteroid QIDx 1 week**ATs PRNWeek 2P.O.AntiBiotic
DiscontinuedNSAID TIDx 1 weekSteroid TIDx 1 week**ATs PRNWeek 3P.O.NSAID
BIDx 1 weekSteroid BIDx 1 week**ATs PRNNSAID QDx 1 week then discontinuedSteroid
QDx 1 week then discontinued**ATs PRNWeek 4P.O.
Surgical Procedure Pre-operative check up
Skin smear examination – insignificantGeneral Examination- Specially search for other septic
focus in the body –insignificantBlood Sugar and Urine examination- MustBlood Pressure and
General Check up – MustLocale Ocular Examination – Tear Drainage System, Intra-Ocular
Pressure, Associated eye diseases- very much essential.History of reaction, relapse and
treatment – HelpfulBiometry
5 AnaesthesiALocal Anaesthesia:– 2% Xylocaine with Adrenaline (4 c.c.) + Inj.
Buviprocaine (Sensorcaine) (3c.c.) :: Peri bulbar InfiltrationInstitallation of 2% ParacainePre-
operative antebiotech & Flurbiprofen to our liveTropical Mydriasis by Tropicamide
6 Operative Technique ECCE by can opener technique
Removal of Cortex by Biway Simogi”sCanulaPCIOLPBHI/Multiple SphincterotomyCloser
of the wound by 4 to 5 interrupted 8-0 VIRGINSILKFormation of A.C. by balanced salt
solutionSub-Conjunctival Injection of Inj. Genticyn + Inj. Dexamethasone
7 Post Operative CareDressing after 24 hours with Tropicamide, Dexamethasone,
AntibioticContinue the medication for two monthsNo role of systemic antibiotic or steroid for
routine casesPatients can go home after 72 hrs.Check up at fortnight interval.Removal of
stitch after two months
8 Post-operative complications and Poor visual outcome
These are the result of –HIGH RISK EYES WHICH ARE STILL OUT OF OUR REACH
TO CONTROL PROPERLY.Hyposthetic CorneaLagophthalmos with exposed
CorneaRelapseReactionCauses unknown
POST OPERATIVE CATARACT CARE INSTRUCTIONS LEAVE YOUR EYE PAD ON
UNTIL YOUR POST OPERATIVE APPOINTMENT THE MORNING AFTER YOUR
SURGERY. DO NOT INSTILL ANY DROPS.  Bathe your eye twice a day (morning &
night) with saline solution. You will need to use a clean gauze square for each wipe across
the lid. Wipe from the inner corner of the eye and outward. Use a fresh gauze square for each
wipe of the eye. DO NOT WIPE THE SURFACE OF YOUR EYE, ONLY YOUR
EYELIDS  Tape your eye shield over the operated eye each night for 1 week post
operatively. This will give you added protection from bumping your eye during the night. 
Use your drops after each bathing and at the other times as directed:  You have 2 types of
drops: o TOBREX (antibiotic drop). o MAXIDEX (anti-inflammatory drop). After your
operation you need to use both types of your drops in the eye that was operated on until your
next appointment with Dr Glastonbury. You should leave about 2 minutes between the
instillation of each type of drop. Shake the eye drop bottles before using them. Drops should
be instilled 4 times a day – BREAKFAST, LUNCH, DINNER & BEDTIME without
touching the surface of your eye with the tip of the bottle. DO - Wear sunglasses while
outdoors, you will be more sensitive to glare in the post-operative phase. - You may read or
watch TV if you can tolerate it, you will not harm your eye. - Ask Dr Glastonbury when you
can drive again. Definitely DO NOT drive on the day of surgery, or the day after surgery. -
Bring your eye drop bottles to the post-operative appointments. DON’T - Don’t rub or put
your fingers into your eye. - Don’t apply pressure to the eye when instilling the eye drops -
Don’t bend your head lower than your chest for 2 weeks. - Don’t lift anything heavy for 2
weeks following your surgery. - Don’t sleep on the same side as your healing eye for 1 week.
Sleep on the opposite side or your back. - Don’t be concerned about washing your hair. You
can wash it under the shower but close your eyes. IMPORTANT Contact the surgery if: 
Your vision deteriorates significantly and suddenly.  If you experience deep, SEVERE pain
in your eye.  If you develop a yellowish discharge from your eye. Please Remember: It is
very important that you have assistance available to you in the immediate postoperative
period when you return home and overnight. You will still have residual anaesthetic agents in
your body and you will also experience a degree of visual impairment due to your operated
eye being patched. This can alter your depth perception when attending to certain domestic
tasks in the home such as pouring hot water. There is also an increased risk of falling post
operatively. It is a requirement of the North Queensland Day Surgery that you have someone
to accompany and stay with you in the immediate post-operative stage. You have had an
operation and you will have some post-operative discomfort as with most surgery. If you
have had your other eye operated on in the past, please be aware that the post-operative phase
for your current surgery may not follow the same recovery path as your other eye surgery.
This is not abnormal.  You may experience some dull aching discomfort in the first 24-hour
period post operatively above your eyebrow or you may experience it as a dull headache. You
should have an effective pain relief available for this period of time should you need it.
Please DO NOT TAKE ASPIRIN for pain following your eye surgery.  You may experience
a sensation of having something in your eye in the first few days’ post operatively. You may
notice your eye is watery. This is your incision and over the first few days you may notice
this sensation particularly when you are blinking, tired or trying to focus on a TV screen or
computer screen when your eye may be a little dry. This sensation will improve. If you are
concerned, please call our rooms on 47 798008 for further instruction and advic