Can a Patient Proceed with Cataract Surgery Under MAC with a Cold Without Active Symptoms?
Yes, a patient with a recent cold but currently without active symptoms can generally proceed with cataract surgery under MAC, as cataract surgery is classified as low-risk and does not involve airway manipulation that would necessitate postponement for minor respiratory illness. 1
Risk Stratification for Cataract Surgery
Cataract surgery is explicitly categorized as very low-risk for major adverse cardiac events (MACE), comparable to plastic surgery in terms of perioperative risk. 1 This classification is critical because:
- Cataract surgery does not involve significant fluid shifts or physiologic stress 1
- MAC anesthesia avoids airway instrumentation, eliminating concerns about aerosol generation or airway reactivity 1
- The procedure is non-major surgery in an asymptomatic patient, which can proceed in conventional surgical circuits 1
Key Decision Points
Symptom Status Assessment
The critical distinction is between "with a cold" (past illness) versus "without active symptoms" (current status):
- If truly asymptomatic now: The patient has recovered from their upper respiratory infection and can proceed 1
- If "without active symptoms" means minimal residual symptoms: Guidelines indicate that even patients with mild symptoms (one minor symptom only) may require postponement until full recovery 1
COVID-19 Considerations (Context-Dependent)
While the provided guidelines focus heavily on COVID-19 protocols, the principles apply to any respiratory illness:
- For symptomatic patients with any respiratory illness: Postponement is recommended until the pathology has recovered 1
- For completely asymptomatic patients: Cataract surgery as non-major surgery can proceed without additional testing 1
- The intervention should be postponed until recovery from other pathology if differential diagnosis suggests non-COVID respiratory illness 1
Clinical Algorithm
Step 1: Confirm Complete Resolution
- No fever, cough, rhinorrhea, or systemic symptoms currently present
- Patient reports feeling fully recovered from the cold
Step 2: Timing Consideration
- If symptoms resolved >7-14 days ago: Proceed without concern 1
- If symptoms resolved <7 days ago: Exercise clinical judgment based on complete symptom resolution
Step 3: Proceed with Standard Protocols
- Postoperative follow-up within 48 hours for low-risk patients 1
- Standard MAC anesthesia protocols without special precautions
Important Caveats
Do not confuse "cold" terminology with temperature-related complications: The literature describes "cold cataract" as a reversible lens opacity from hypothermia exposure 2, and cold balanced salt solution has specific intraoperative applications 3, 4. These are unrelated to upper respiratory infections.
The phrase "without active symptoms" must mean truly asymptomatic. Any persistent symptoms—even minor ones—warrant postponement until complete recovery, as guidelines consistently recommend delaying elective surgery until respiratory pathology has fully resolved. 1