The Eye-Drop Schedule for the First Four Weeks After Cataract Surgery

The eye-drop regimen is the single most important post-operative task after cataract surgery, and missed doses are the leading cause of inflammation, infection, and delayed healing. The American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and most US surgical centers prescribe a three-drop protocol: an antibiotic for the first week, a steroid anti-inflammatory tapered over four weeks, and a non-steroidal anti-inflammatory, called an NSAID, also tapered over four weeks. The specific drops vary by surgeon, but the pattern is consistent across accredited surgery centers.

The antibiotic is usually a fourth-generation fluoroquinolone, such as moxifloxacin brand name Vigamox, gatifloxacin brand name Zymaxid, or besifloxacin brand name Besivance. The dose is one drop in the surgical eye four times a day for seven days, starting the day after surgery. The antibiotic prevents endophthalmitis, a rare but devastating infection inside the eye. Endophthalmitis occurs in about 1 in 3,000 cataract surgeries when antibiotic drops are used correctly, and the rate rises sharply when drops are missed in the first three days.

The steroid is usually prednisolone acetate 1 percent, brand name Pred Forte, or difluprednate, brand name Durezol. The dose starts at four times a day for one week, then drops to three times a day in week two, twice a day in week three, and once a day in week four. The steroid suppresses inflammation from the surgical trauma. Skipping doses in the first two weeks can lead to cystoid macular edema, a swelling of the central retina that causes blurred vision and can take months to resolve.

The NSAID is usually ketorolac, brand name Acular LS, or bromfenac, brand name Prolensa. The dose is one drop in the surgical eye once or twice a day for four weeks. The NSAID works alongside the steroid to prevent macular edema and is especially important for patients with diabetes, who have a higher edema risk. All three drops must be timed at least five minutes apart, because applying them back-to-back washes out the first drop before it absorbs. Sources: aao.org/eye-health/treatments/cataract-surgery-recovery, ascrs.org/patients/post-op-care, and medicare.gov/coverage/cataract-surgery.