Eye drops after cataract surgery: why there are three bottles and why the schedule tapers

Cataract surgery itself takes twenty minutes. The part you do at home takes four to six weeks, and it is mostly eye drops. Patients are handed a printed schedule with two or three bottles, several times a day, changing every week, and it is easy to lose track of which bottle does what and why the counts keep dropping.

This article explains the logic behind the schedule so it is easier to follow. It does not replace the schedule your surgeon gave you. If anything here differs from your printed sheet, the sheet wins.

The three kinds of drop

Most post-operative regimens combine drops from three groups. Yours may have all three, or two, and sometimes a fourth.

An antibiotic drop. Its job is to keep bacteria out of the eye while the small incision seals. It is usually the shortest course, typically the first one to two weeks, and it usually stops abruptly rather than tapering.

An anti-inflammatory drop, usually a steroid. Surgery, however gentle, inflames the inside of the eye. Untreated, that inflammation causes pain, blurred vision and, occasionally, swelling at the back of the eye that slows recovery. The steroid drop controls it. This is the bottle with the changing schedule, for reasons explained below.

A lubricating drop. The eye’s surface is often dry and gritty for a few weeks after surgery. Lubricants are for comfort, are safe to use freely, and are often the only drop you continue after the others stop.

Some surgeons add a non-steroidal anti-inflammatory drop alongside the steroid, particularly for patients with diabetes or a history of swelling at the back of the eye. Some combine the antibiotic and the steroid in one bottle. Your sheet will say.

Why the steroid drop tapers

The steroid schedule usually starts at several times a day and steps down every week: four times, then three, then twice, then once, then stop.

Two things are going on. First, inflammation after surgery is highest in the first days and falls steadily, so the eye needs less each week. Second, and more importantly, stopping a steroid suddenly can let inflammation flare back up, sometimes worse than before. Stepping down gives the eye time to take over on its own.

There is a third reason to follow the taper closely rather than stretching the course out. In some people, steroid drops raise the pressure inside the eye. That is one of the things your surgeon checks at each review visit, and one reason the course is not open-ended.

The practical consequence: do not stop the steroid early because the eye feels fine, and do not keep using it beyond the sheet because it feels soothing. Follow the taper as written, and if you lose the sheet, call the clinic and ask rather than guessing.

Putting drops in properly

Most drops that “do not work” never reached the eye. A few habits help.

• Wash your hands first, every time.
• Tilt your head back, pull the lower lid down gently with a finger to make a small pocket, and drop into the pocket rather than onto the eyeball. Look up while you do it.
• One drop is enough. A second drop just runs down your cheek.
• Close the eye gently for a minute afterwards. Do not squeeze, and do not rub.
• Do not let the bottle tip touch the eye, the lashes or your fingers. If it does, the bottle is no longer sterile.
• Wait about five minutes between different drops. If you put two in back to back, the second washes the first out.
• If a bottle says “shake well”, shake it. Some steroid drops are suspensions, and the medicine settles at the bottom.
• A drop that stings for a few seconds is normal. A drop that keeps stinging or blurs your vision for a long time is worth mentioning at your review.

If you cannot manage drops yourself, a family member can be taught in a minute, and the clinic will happily show them.

Mistakes we see at the counter

Running out mid-taper. Bottles are small. If a bottle is running low before the schedule ends, buy the next one before it is empty, not after.

Swapping brands without asking. Pharmacies sometimes substitute a different brand of the same drug. For most drops that is fine, but the concentration and the type of steroid matter, so if the bottle you are handed does not match the name on your prescription, ask the pharmacist to confirm it is the same medicine and strength.

Using an old bottle. Eye drops are usually discarded a month after opening, whatever the printed expiry says. Do not finish a course with a bottle opened for an earlier problem.

Sharing drops between eyes when only one was operated. Your schedule is for the operated eye. If both eyes are operated a few weeks apart, each eye has its own schedule and, ideally, its own bottles.

Stopping everything once vision is clear. Vision often clears within days. The inflammation inside the eye takes weeks. Keep going.

When to call the same day

Cataract surgery is one of the safest operations there is, and most recoveries are uneventful. A few symptoms are not part of a normal recovery and should be reported to your surgeon or clinic the same day, or to an emergency eye service if the clinic is closed:

• Pain that is getting worse rather than better, especially with a red eye.
• A sudden drop in vision after it had been improving.
• Increasing redness, a swollen lid, or sticky discharge.
• Many new floaters, flashes of light, or a curtain across part of your vision.
• Any injury to the eye.

A serious infection inside the eye after surgery is rare but is an emergency measured in hours, and the earlier it is treated the better the outcome. Nobody at an eye clinic minds a call that turns out to be nothing.

Keep the printed schedule

Ask for the drop schedule in writing if you were not given one, stick it on the fridge, and tick off each dose. If your clinic sends the schedule to your phone or files it with your visit summary, save it. It is the one document that answers most of the questions you will have over the next month.