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Pain above eye in order after cataract surgery

I had a vitrectomy and scleral buckle 1 year ago to repair a retinal detachment. I recovered well and experienced little post-op pain. The cataract that formed was removed 3 days ago and I now have moderate to severe pain when I rotate my eye upward. I reported this to the surgeon at my next-day recheck, and he said this was normal. My eye pressure was up slightly (25) and he inserted a needle to promote fluid drainage, saying the trabecular mesh work sometimes collapses and this fixes it. I called again yesterday to report the pain hadn't changed, and he still insisted this was normal. I am wondering if the scleral buckle somehow shifted due to the increased pressure or some other reason. It is a holiday weekend,  so I don't know when I will be able to contact anyone, but I plan to call the retinal surgeon to ask about this. Any other ideas why I might be having pain here?
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Avatar universal
Edit: Should read pain in the orbit, not order
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That much pain is not normal for regular surgery on a non-RD eye.  Varies with scleral buckle.  These cases are all the same so I don't think it is right to tell you its normal. Some post RD scleral buckles have no pain at all. I would contact the retina surgeon as soon as possible to discuss. The retina surgeon will need to exam you eye again some time after it has healed from the cataract surgery.
Thank you, Dr. Hagan. I have researched online and can find no reports of similar pain after cataract surgery. I do see the possibility of cellulitis or the rare Tolosa Hunt syndrome. The pain has not changed, it is a stabbing pain when I rotate my eye straight up. I will try calling the retina surgeon's office tomorrow. I have an appointment with him in 1 month, as well as an appointment with my regular optometrist at the end of this week.
Hopefully the retina surgeon can help or offer insights. The cataract surgeon should not hide behind the referring optometrist. Proper cataract surgery care includes access to the surgeon immediately if something out of the normal occurs.
I agree. I have an appointment this morning with the retina surgeon.
Thanks. Let readers know how this turns out as a learning experience.
Hello Dr. Hagan, I thought I had left a comment about my appointment with the retinal surgeon but I don't see it here. He thought there may have been stretching or swelling behind the eye but he was not sure. I went to my regular optometrist 3 days ago and he thought the pain might be as a result of the nerve block injections, but my records state that the injections were intraocular. Either way, the pain is nearly gone. I have another follow-up appointment with my optometrist this week.

HOWEVER, my optometrist was surprised that the cataract surgeon did not have me using NSAID drops only Tobra-DexST. I did some research and it seems to be standard of care to use BOTH medications prior to and continuing after cataract surgery to help prevent CME, even in low-risk patients. I asked the optometrist to prescribe an NSAID if he thought it was still indicated and he did so. I have been using Bromfenac once daily for only 2 days. Now I have another reason to doubt the care I received from the cataract surgeon. Although my eye is healing and my vision is fairly good, I am conflicted about whether to say anything to the cataract surgeon and whether to go back to him to have the other eye done. He is a well-respected doctor in my local area, although I sense that the retinal surgeon and he are not on the best of terms. The cataract surgeon is older (I am 60 and I believe he is my age or a bit older). I am wondering if he is just not keeping up with recommendations or he just has his own way of doing things and nothing bad has happened. He also did not want to see me until a month after the surgery, whereas the optometrist said the eye should be rechecked weekly for 1 month.  My eye has had lots of trauma because of the retinal detachment surgery; I do not want to deal with possible CME!  I am a veterinarian, and I know I am uncomfortable hearing from a client that they are dissatisfied, although it is important to know. I would appreciate your opinion.
I would at least get a second opinion from another highly regarded cataract/IOL surgeon that is close enough that you could commute  back and forth.  Most surgeons use steroids and NASAID drops.   However some inject the medications into the eye at the end of surgery so that drops are not necessary post operative. This is new and controversial.  If you are a Vet you understand 2nd opinions  and that not all Vets are the same.
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