Post Cataract Surgery, my Eyes Seem to Be Different Sizes. Is This Possible?

One eye should not be smaller than the other, one of your eyelids may be drooping. 

 

Please see your ophthalmologist immediately, as this can have a number of causes and some of them are significant.  If the drooping lid is just post-surgical, it will usually resolve within six months without further treatment. However, it is important to have your ophthalmologist determine the cause and to ensure there is nothing serious going on as a result of your cataract surgery.

The most common reason might be a little ptosis after the surgery. It usually resolved. Sometimes people with new monovision have a subtle squint as they adjust to using both eyes together. Finally, you could have some lingering inflammation or toxicity to drops or a complication related to drugs injected under the skin of the eye. In any case, see your surgeon soon and take some pictures. 

The eyelid may droop more after cataract surgery. This is not common however. Patients sometimes become more observant of their eyelid position once their vision is clearer and glasses are no longer needed.

The eyeball size does not change with cataract surgery.  On rare occasions, the lid can droop (ptosis) after ocular surgery giving the appearance that the eye is smaller.  Your “blended” or “mini-monovision” is an excellent way to become less dependent on spectacles, though it may take a few months for the brain to adapt.  A few individuals are unable to adapt and glasses or contact lenses may be needed post-op.

The appearance of your eyes may be different after cataract surgery.  Sometimes, there is more swelling in one eye than the other and your two eyes are at different stages based upon the separation in time.  Other things that cause droopiness of your eyelids is stretching of the eyelid muscle due to the eyelid holder used at the time of surgery, a reaction of the eyelid due to irritation of the front surface of the eye and the incisions that were made, reaction to the eyedrops, and swelling.  Try to be patient as most of the time resolution occurs.  If it still persists after about six months, surgical intervention may help. 

I am glad you are reaching out for help in this situation. Any time something does not seem quite right to you as a patient, I encourage that you reach out right away to your doctor or surgeon. Cataract surgery, whether your vision is corrected only for distance, or whether you have premium lenses implanted - or if in your case your vision is corrected for what we call "monovision," your eyes should not become asymmetrical. Does it appear that one eye is protruding more than the other, or could you have one eyelid that is drooping and making the eye appear smaller? I encourage you to contact your provider right away and get things checked out. Your vision is precious, and you deserve the proper care!

It is not uncommon to see a mild upper eyelid lag for about one to two weeks after cataract surgery. This is in no way permanent. The cause is typically a combination of a swelling reaction by the upper eyelid muscles to the surgery itself and a mild reaction to one of the postop eye drops. The steroid eye drop, which is used for approximately two weeks postoperatively, can cause that upper eyelid muscle to relax a bit while you are using it. Once the steroid is stopped, and a few weeks pass, the eyelids return to normal position. Since cataract surgery is performed on one eye at a time, typically one or two weeks apart, what you are noticing is not an uncommon question. If the difference between the eyes continues then you should discuss this with your cataract surgeon.