What eye drops are recommended for comfort after retina surgery, especially for stitch comfort?

Eye Drops for Comfort After Retina Surgery

For comfort after retina surgery, use preservative-free artificial tears (such as carmellose or hyaluronate) every 2 hours, combined with topical NSAIDs (ketorolac or nepafenac) for pain control, and consider short-term topical corticosteroids to reduce inflammation. 1, 2, 3

Primary Comfort Measures

Artificial Tears for Lubrication

• Preservative-free ocular lubricants are the cornerstone for stitch-related discomfort, with hyaluronate or carmellose eye drops applied every 2 hours providing optimal surface lubrication and comfort 1, 4
• Preservative-free formulations are strongly preferred to minimize ocular surface toxicity, particularly important in the postoperative setting where the ocular surface is already compromised 2, 3

NSAIDs for Pain Control

• Topical NSAIDs (ketorolac 0.45% or nepafenac 0.1%) are highly effective for postoperative ocular pain and should be used within the first postoperative month 2, 3, 5
• Nepafenac has superior corneal permeability characteristics and may provide unique efficacy for posterior segment procedures like retina surgery 5
• NSAIDs reduce pain through cyclooxygenase inhibition and prevention of prostaglandin synthesis 5

Critical caveat: NSAIDs should be prescribed judiciously as they may delay corneal epithelialization and have been associated with corneal melting or perforation with prolonged use 1

Topical Corticosteroids for Inflammation

• Topical corticosteroids (prednisolone acetate 1% or dexamethasone 0.1%) reduce inflammation and improve comfort, typically started immediately after surgery and tapered over days to weeks 1, 2, 3
• Preservative-free dexamethasone 0.1% twice daily may reduce ocular surface damage 1
• Monitor intraocular pressure closely as prolonged corticosteroid use causes IOP elevation in a significant proportion of patients 1, 6

Adjunctive Comfort Measures

Bandage Contact Lens

• A therapeutic bandage contact lens significantly reduces postoperative pain and provides mechanical protection for sutures 1
• The lens can be discontinued once significant re-epithelialization has occurred, typically within 5 days 1

Oral Analgesics

• Some patients benefit from oral analgesics (NSAIDs or opioids) for additional pain control, particularly in the first few days postoperatively 1

Topical Anesthetics (Use With Extreme Caution)

• Small quantities of dilute topical anesthetic may be used for severe discomfort but warrant close supervision 1
• Anesthetic drops delay corneal epithelialization and should be prescribed very judiciously 1

Antibiotic Prophylaxis

• Topical antibiotics (moxifloxacin 0.5% three times daily) are routinely administered postoperatively to prevent infection 3, 7
• Continue until epithelial healing is complete, typically 5-7 days 1, 3

Postoperative Monitoring Schedule

• Day 1: Slit-lamp examination to assess epithelial healing and rule out infection 1, 2
• Every several days: Continue monitoring until epithelium is healed 1
• Weeks 1-2: Check for infection, inflammation, or ocular surface damage 2, 3
• 1 month: Evaluate treatment effect and assess for steroid-related complications 2, 6

Common Pitfalls to Avoid

• Avoid preserved formulations in the postoperative period as they significantly increase risk of ocular surface toxicity 2, 3
• Do not use NSAIDs without concomitant corticosteroids as sterile corneal infiltrates have been described with NSAID monotherapy 1
• Never use topical anesthetics routinely as they delay healing and increase infection risk 1
• Monitor for microbial keratitis whenever a corneal infiltrate is seen, as infection must be differentiated from sterile inflammation 1