Opioid Use Duration Should Be Reduced After Ocular Surgery: Anton Kolomeyer, MD, PhD

Why It Matters

Extended opioid use after eye surgery can fuel dependence and exacerbate the national opioid crisis, prompting the need for tighter prescribing standards in ophthalmology.

Key Takeaways

• Opioid fills rose after ocular surgery from 2014‑2016 vs 2000‑2001
• Trauma, pediatric, and extensive eye surgeries show highest prescription rates
• Recommended opioid course length: five to seven days post‑procedure
• Surgeons urged to audit personal prescribing habits regularly
• Shorter opioid duration reduces risk of dependence and misuse

Pulse Analysis

The surge in postoperative opioid prescriptions among eye‑surgery patients mirrors a broader national pattern of increasing opioid reliance. While ophthalmic procedures are often perceived as low‑pain, data from Kolomeyer’s 2019 study reveal a marked uptick in prescription fills during the mid‑2010s, suggesting that clinicians may be defaulting to opioid analgesics out of habit rather than necessity. This trend is especially pronounced in high‑intensity surgeries—such as scleral buckling, pediatric interventions, and trauma repairs—where pain management protocols have historically leaned on stronger painkillers.

Subspecialty analysis underscores that not all ocular surgeries carry the same risk. Cataract and routine glaucoma procedures typically involve minimal discomfort, yet the study found that even these cases sometimes receive opioid scripts, reflecting a lack of nuanced guidelines. In contrast, complex retinal or trauma cases understandably see higher opioid use, but the data indicate that many prescriptions extend beyond the recommended five‑to‑seven‑day window. This overprescribing not only raises the likelihood of patient dependence but also contributes to excess medication in the community, a known driver of diversion and misuse.

Kolomeyer’s call to action centers on clinician self‑audit and evidence‑based prescribing limits. By adopting a five‑to‑seven‑day cap and prioritizing non‑opioid analgesics when appropriate, ophthalmologists can significantly curb unnecessary exposure. Implementing electronic health‑record alerts, standardizing postoperative pain protocols, and educating patients on realistic pain expectations are practical steps. As the specialty aligns its prescribing habits with broader opioid stewardship efforts, it can protect patients while reinforcing its role in combating the epidemic.