Pain after cataract surgery day by day: what is normal, what is not

Modern phaco cataract surgery is one of the least painful operations in medicine — but 'painless' is not the same as 'no sensation'. Nearly every patient feels something, and the pattern of that discomfort follows a predictable curve. Here is what to expect, hour by hour and day by day, and the specific symptoms that should trigger a same-day call.

For the wider recovery picture, see my cataract surgery recovery day by day guide. This piece focuses specifically on pain and discomfort.

Hours 0–6 — the anaesthetic wears off

Surgery is performed under topical (drop) anaesthetic, sometimes with a small intracameral injection. You feel pressure — never a sharp cutting sensation — during the operation itself.

In the first six hours after you get home:

- The eye feels heavy, watery and slightly bruised, similar to swimming with your eyes open in chlorinated water.

- A dull ache behind the eye is common and usually settles with a single dose of paracetamol.

- Light sensitivity is intense — this is the still-dilated pupil, not damage.

- Do not take ibuprofen or other NSAIDs unless your surgeon has advised it, as they can slightly increase the risk of a small subconjunctival bleed.

Sharp, escalating pain in this window is unusual and should be reported.

Day 1 — the gritty day

The commonest description on day 1 is *'as though there is an eyelash in my eye'*. This foreign-body sensation comes from the tiny corneal wound and the drying effect of the drops. It is not damage and does not need painkillers — preservative-free artificial tears between prescribed medications help most.

Expected on day 1:

- Mild grittiness and watering

- A dull ache when you first wake up, easing over the morning

- Redness on the white of the eye (a harmless subconjunctival bleed)

Not expected on day 1: throbbing pain, pain that wakes you at night, or pain that needs more than paracetamol.

Day 2–3 — grittiness fades

By day 2 most patients no longer need any painkillers. Grittiness usually halves each day. If discomfort is worsening rather than improving from day 2 onwards, that is the single most useful warning sign — call the clinic the same day.

Screens do not cause pain but do cause dryness; use lubricating drops every 1–2 hours during screen work in the first week.

Day 4–7 — comfort returns

By the end of week one, most patients forget they have had surgery for hours at a time. Any residual sensation is usually a mild scratchiness on waking, gone within an hour of the first morning drop.

Weeks 2–4 — occasional twinges

A brief sharp twinge in the operated eye once or twice a week during weeks 2–4 is common as the tiny corneal wound finishes healing. It lasts seconds, not minutes, and needs no treatment. Persistent pain at this stage is not normal.

What actually helps

- Paracetamol 1 g up to four times a day for the first 24–48 hours if needed

- Preservative-free artificial tears (e.g. hyaluronate drops) between prescribed medications

- Sunglasses outdoors and in bright indoor light for the first week

- Sleeping with the plastic shield taped on for the first 7 nights

- Keeping the head elevated on two pillows for the first 2 nights

Red flags — call the same day

Contact the clinic or your nearest eye A&E immediately if you develop any of the following:

- Severe pain that paracetamol does not touch

- Pain that wakes you from sleep

- Pain with a sudden drop in vision

- A red, sticky, painful eye with discharge

- New floaters, flashing lights or a dark curtain across your vision

These features can indicate raised intraocular pressure, infection (endophthalmitis) or retinal detachment — all rare but time-critical.

Next steps

If you are researching what to expect before booking, our fast-track cataract pathway includes a detailed pre-op discussion of what your specific eye will feel like during recovery. Book online or call **020 3137 3237**.