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Cataract surgery: anesthesia and testing beforehand

What guidelines say about numbing the eye, and what a large trial found about routine tests before cataract surgery.

2 minute read4 sources, each checked word for wordLibrary checked October 18, 2026

In short

  • Surgery is the only effective treatment for cataract.E2Good1
  • A 2024 European guideline names topical anesthesia (numbing drops) as the preferred technique.E2Good1
  • Routine medical tests before cataract surgery did not make it measurably safer in a trial of over 19,000 operations.E1Strong2

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades mean

How is the eye numbed?

Cataract is a leading cause of visual impairment worldwide, and surgery is the only effective treatment.E2Good1

The European Society of Cataract and Refractive Surgeons' guideline recommends topical anesthesia as the preferred technique. It also recommends antibiotics inside the eye to prevent infection.E2Good1

At the lightest level of sedation, minimal sedation, people respond normally to speech, and breathing and circulation are unaffected.E2Good3

Are routine tests needed beforehand?

A randomized trial assigned 19,557 cataract operations to have, or not have, a standard set of tests. The tests (an ECG, blood count and blood chemistry) were in addition to a history and physical exam.E1Strong2

Routine testing did not measurably increase the safety of the surgery. The most frequent medical events in both groups were treatment for high blood pressure and slow heart rhythm.E1Strong2

Guidance on blood thinners has separate recommendations for eye procedures and other minor procedures.E2Good4

Questions you might bring to your anesthesia team

  1. Will my eye be numbed with drops, an injection, or both, and will I have sedation?
  2. Which tests, if any, do I need before surgery?
  3. What is the plan for my blood thinner, if I take one?
  4. Should I take my usual morning medicines on the day?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. ESCRS guideline for cataract surgery 2024: executive summary. Wanten JC, J Cataract Refract Surg, 2026. E2Good Guideline
    The words this page rests on
    Cataract is a leading cause of visual impairment globally, with surgery as the only effective treatment.
    Recommendations include intracameral antibiotics to prevent endophthalmitis, topical anesthesia as the preferred technique, and toric intraocular lenses for corneal astigmatism ≥1.0 diopter.
  2. The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery. Schein OD, N Engl J Med, 2000. E1Strong Randomized trial
    The words this page rests on
    Routine medical testing before cataract surgery does not measurably increase the safety of the surgery.
    We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination.
    The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia).
  3. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. American Society of Anesthesiologists, 2024. E2Good Guideline
    The words this page rests on
    Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.
  4. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Douketis JD, Chest, 2022. E2Good Guideline
    The words this page rests on
    There are separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and GI (endoscopic) procedures.