RESOURCES
United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS)
Recommendations of Practice for Dropless Cataract Surgery 2026
Overview
Dropless Cataract Surgery (DCS) is a practice that seeks to replace courses of postoperative topical eye drops, administered by patients or their caregivers, with depot or other single-dose medications administered by the surgeon at the end of surgery.
A more comprehensive approach to DCS may also extend to the abandonment of preoperative eye drops, whereby analgesia and pupillary dilation are instead achieved through intraoperative depot medications. However, these recommendations and summary focus purely on the avoidance of postoperative eye drops.
Postoperative cataract surgery management has traditionally required 3-4 weeks of topical eye drops—typically antibiotics, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)—to prevent infection and control inflammation. While effective, drop regimens are costly, inconvenient, have an environmental impact and are prone to poor compliance, especially amongst elderly patients who may struggle with instillation technique or memory.
Dropless cataract surgery is an approach in which surgeons administer intraocular or periocular medications during the procedure, eliminating or significantly reducing the need for postoperative drops. Methods include intracameral antibiotics, subconjunctival depo steroid injection and NSAID intracameral irrigation during surgery.
Benefits include improved patient compliance, reduced risk of postoperative complications from missed or incorrect dosing, and simplified postoperative care. Studies suggest comparable outcomes to standard drop regimens in terms of infection and inflammation control. However, concerns remain regarding potential complications such as elevated intraocular pressure, and the need for careful patient selection. Furthermore, there are currently no MHRA-licensed periocular or intraocular products indicated for the treatment of intraocular inflammation.
There remains a lack of national guidance in this approach to routine uncomplicated cataract surgery with varied practices occurring across various NHS and independent sector healthcare providers.
