Constipation after cataract surgery

[Klat]

I had terrible constipation after cataract surgery and strained to go to the bathroom.  Could this have caused my iol to shift?  What other damage could this cause?  Thank you

[flossy93]

There is a possible eye-related complication of heavy straining such as lifting a heavy weight, prolonged coughing or sneezing, severe constipation straining, etc.  It is called 'Valsalva Retinopathy' and generally is a breakage of small blood vessels in the retina.

Please be aware I am NOT implying that this happened for you!  But you asked whether severe constipation can cause damage, and there is a small chance that it can.

When a person holds their breath and strains hard, the blood pressure in the head and/or abdomen can increase locally.  If this is severe enough and for long enough, tiny capillaries in the retina, cornea or sclera may break and bleed.  If bleeding occurs in the retina, this can cause vision symptoms which, although alarming, usually resolve over time.

Here is a quote from a Review of Optometry article about Valsalva retinopathy:

"Ocular complications typically result from the rupture of small blood vessels in various tissues. Most commonly, this is seen as a non-traumatic subconjunctival hemorrhage. Valsalva retinopathy is another distinct and well-documented ocular manifestation of this phenomenon. All of these complications may be seen with increased frequency in patients who use systemic blood thinners (i.e., warfarin)."

The journal Eye describes possible contributing factors as follows: "It [Valsalva retinopathy] has been associated with certain sports such as weight-lifting, aerobic exercise and on a day-to-day basis with constipation, pregnancy, labour, and blowing up balloons.

The journal Eye goes on to note: "The presentation of Valsalva retinopathy can be variable depending on the size of the vessel involved and the location of the haemorrhage; subretinal, intraretinal, and/or subhyaloid. Prognosis is generally favourable with most cases resolving spontaneously over a span of several weeks, leaving little if any visual impairment."

So, if you want to avoid the tiny risk to the eye from heavy straining, see your regular doctor if you continue to have problems with constipation that might lead you to strain.

You should already have had followup with your surgeon after your cataract surgery; the surgeon should be able to detect if the IOL has shifted position (not  likely, as Dr. Oyakawa has noted).  

If going forward you do notice any change in your vision since the surgery (especially declining vision or new visual symptoms), please go see your ophthalmologist promptly.  

[Ray T Oyakawa, MD]

It will not cause a problem.

Dr. O.