Ophthalmic Surgery in Cirrhosis

  • Jila Noori
  • Andrew W. Eller


When planning an eye surgery for patients with cirrhosis, as with any surgical intervention, it is important to assess their propensity for abnormal bleeding. This factor must be taken into consideration for both anesthesia as well as the selection of the surgical technique. In cases with a hypocoagulopathy, less invasive anesthesia techniques, including topical with or without intracameral, subconjunctival, and sub-Tenon injections, are safer choices. Whenever possible, it is best to avoid the use of a standard retrobulbar injection due to the risk of blindness from a retrobulbar hemorrhage.

Modern cataract surgery with the phacoemulsification technique and insertion of a foldable intraocular lens (IOL) is typically performed through an avascular corneal incision, under topical anesthesia, without any risk of bleeding. Bleeding has become less of an issue with vitreoretinal procedures as the scleral incisions are now much smaller. There is a greater concern when performing oculoplastic procedures on the highly vascularized eyelids.

The other major factor of importance is to assess the cirrhotic patient for the ability to lie comfortably in a supine position for the extent of the entire operation. It is also important for the ophthalmic surgeon to be aware of potential tear-film deficiencies in these patients, as a significant number are at greater risk for postoperative ocular surface disorders.


Cataract surgery Vitrectomy Choroidal hemorrhage Retrobulbar hemorrhage Ophthalmic anesthesia Dry eye syndrome 


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.The Retina Service, Department of OphthalmologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.The Retina Service, UPMC Eye Center, Department of OphthalmologyUniversity of Pittsburgh School of Medicine, The Eye and Ear InstitutePittsburghUSA

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