Itchy Eyes After Cataract Surgery
Yes, itchy eyes are a common symptom after cataract surgery, occurring in approximately 38-52% of patients during the postoperative period, and are typically part of the broader spectrum of ocular surface discomfort that includes burning, foreign-body sensation, and tearing. 1
Understanding Post-Cataract Surgery Itchiness
Itching after cataract surgery is primarily related to:
- Dry eye disease (DED) development or exacerbation, which is a well-recognized complication of cataract surgery that can cause or worsen pre-existing ocular surface symptoms 2
- Ocular surface inflammation, which is an expected response to surgical trauma and typically peaks within the first 2 weeks after surgery 3
- Medication-related irritation, particularly from preserved eye drops containing benzalkonium chloride (BAK), which can damage the ocular surface and cause itching 2
Risk Factors for Postoperative Itching
You are at higher risk for experiencing itchy eyes if you have: 2
- Pre-existing dry eye disease (moderate to high risk)
- Allergic conjunctivitis (high risk)
- Contact lens use (high risk)
- Current use of BAK-containing eye drops (high risk)
- History of previous cataract surgery-induced DED (very high risk)
- Autoimmune conditions like Sjögren's syndrome or rheumatoid arthritis (high risk)
Management Approach
Immediate Post-Surgery (First Month)
The American Academy of Ophthalmology strongly recommends using preservative-free formulations for all postoperative eye drops, especially in high-risk patients, to minimize ocular surface irritation and itching. 4, 5
Standard treatment includes: 4, 6, 5
- Preservative-free artificial tears for symptomatic relief of itching and dryness
- Topical corticosteroids (prednisolone acetate 1% or loteprednol) to control inflammation, though these can cause itching as a side effect in 5-15% of patients 7
- Topical NSAIDs (nepafenac or ketorolac) within the first month to reduce inflammation
Important Caveat About Steroid Side Effects
While corticosteroids are essential for controlling postoperative inflammation, the FDA drug label for loteprednol specifically lists itching as an ocular adverse reaction occurring in 5-15% of treated patients. 7 This creates a clinical dilemma where the treatment itself may contribute to the symptom.
Beyond the First Month
If itching persists after 1 month, more aggressive DED management is warranted: 2, 6
- Continue preservative-free artificial tears
- Consider punctal plugs
- Topical cyclosporine for chronic inflammation
- Eyelid warming therapy (particularly helpful for meibomian gland dysfunction)
- Mucin secretagogues
Critical Follow-Up Timeline
Monitor for itching and other symptoms at: 4, 6, 5
- Day 1: Check for early signs of infection or severe inflammation
- Weeks 1-2: Assess for dry eye occurrence and ocular surface damage
- 1 month: Evaluate treatment effect and tear break-up time
- 2-3 months: Ensure resolution of symptoms
When to Be Concerned
Contact your surgical center immediately if itching is accompanied by: 6
- Sudden or worsening vision changes
- Increasing pain or redness beyond expected levels
- Discharge from the eye
- New flashes, floaters, or curtain-like vision loss
Common Pitfalls to Avoid
- Using preserved eye drops in high-risk patients significantly increases the risk of ocular surface toxicity and worsening itching 5
- Inadequate treatment of pre-existing dry eye before surgery increases postoperative symptoms 2
- Confusing itching with allergic conjunctivitis when it may actually be medication toxicity or DED 2
Prognosis
The good news is that postoperative itching and ocular discomfort typically improve over time. 1 While symptoms are common in the first 6 weeks (38-52% of patients), most patients respond well to appropriate treatment with preservative-free formulations and aggressive DED management. 2, 1 Early onset postoperative inflammation and associated symptoms like itching do not typically decrease final visual acuity or cause permanent ocular sequelae when properly managed. 3