Complications of Cataract

An untreated cataract does not stay politely still - it hardens, swells, and can inflame the eye from inside. And cataract surgery, though remarkably safe, has its own short list of risks. Both sides belong here.

Complications of the untreated cataract

• Hypermature (Morgagnian) cataract: the lens liquefies and leaks protein - this can trigger painful inflammation and lens-induced glaucoma, an emergency that can cost the eye
• Lens-induced glaucoma: a swollen intumescent cataract physically blocks fluid drainage - pressure rises, pain begins, and now TWO diseases threaten sight
• Phacolytic/phacomorphic crises: the leaked or swollen lens sets off inflammation and pressure spikes - red, painful, urgent
• Subluxation: a hypermature lens can slip from its moorings
• Harder surgery: a rock-hard mature cataract makes the eventual operation longer, riskier and slower to heal - delay actively worsens the surgical odds
• The invisible companions: a dense cataract hides the retina behind it - diabetic retinopathy or macular disease can progress unseen while everyone waits

Complications of surgery (uncommon, mostly treatable)

• Posterior capsule opacification: the commonest by far - the membrane behind the new lens hazes months or years later ("after-cataract"); fixed with a 2-minute painless laser in the clinic
• Cystoid macular edema: retinal swelling blurring central vision weeks after surgery - usually settles with drops
• Endophthalmitis: infection inside the eye - rare (well under 1 in 1000) but the true emergency: increasing pain, redness, falling vision in the first week after surgery means SAME-DAY return to the surgeon
• Retinal detachment: rare, slightly higher after cataract surgery - new flashes, floaters or a curtain over vision at any later date means urgent review
• Raised eye pressure, corneal swelling, lens-position problems: uncommon, managed when caught - the follow-up visits exist for exactly this

The warnings to carry home

• After surgery: increasing pain + worsening vision + redness = same-day emergency, not a wait-and-watch
• Untreated for years: a blind painless eye can turn into a blind PAINFUL eye (lens-induced glaucoma) - the worst bargain in eye care
• Sudden flashes, floaters or a curtain at any time = retinal emergency, 24-48 hours

The classics warned about bad timing too

Sushruta's own caution: piercing an immature cataract, or a faulty puncture (mithya vedhana), brings severe pain, intraocular bleeding and adhimantha - the classical name for the acute pressure-crisis eye - and can end in incurable blindness. The ancient text's instruction was the modern one: the right stage, the right hands, or not at all.

One-line summary

Delay hardens the lens and can ignite painful glaucoma; surgery's own risks are uncommon and nearly all treatable when the follow-up visits and the same-day emergency rule are honored.