Preparing for Vitrectomy: Fasting, Medication Review and Arranging Help for the First Days

The kitchen table is covered in paper: a consent form, a leaflet about eye drops, a sheet with the word FASTING in capitals, and a handwritten list that says only “call Maria about a lift.” The macular hole was found three weeks ago, the surgery is booked, and the person sitting there has read enough to be worried but not quite enough to feel ready.

That gap is normal. Preparing for vitrectomy is less about medical knowledge than about logistics done in the right order: knowing when to stop eating, which of your tablets need a conversation before the day, and who will be in the house afterward when you cannot drive, cannot see well from one eye, and may be lying face down for hours at a time.

This explainer works through each of those pieces in the order they tend to come up, using what mainstream guidance actually says rather than what the internet assumes.

What actually happens during a vitrectomy?

The vitreous is the clear gel that fills the back of the eye and sits against the retina, the light-sensing layer that lines the inside of the eyeball. A vitrectomy removes some or all of that gel so the surgeon can reach and repair the retina underneath. Most modern operations are done through the pars plana, a narrow band of the eye wall a few millimeters behind the colored iris where instruments can enter without damaging the retina, which is why you may see the full name “pars plana vitrectomy” on your paperwork.

Three tiny ports are placed through the white of the eye. One carries fluid in to keep the eye inflated, one holds a fiber-optic light, and one holds the working instrument, usually a cutter that slices and suctions the gel in small bites. Once the vitreous is out, the surgeon works on whatever brought you there: peeling a membrane off the retina, sealing a tear with laser, or clearing blood that has clouded your vision.

The eye is then refilled. Sometimes plain saline is enough. Often the surgeon leaves a tamponade, which is a substance that presses the retina flat while it heals. Gas bubbles absorb on their own over weeks; silicone oil stays until it is removed at a later operation. MedlinePlus and Mayo Clinic both describe the procedure as commonly done under local anesthesia with sedation, though general anesthesia is used when needed, and as usually completed as a day case.

Knowing which tamponade your surgeon plans to use matters more than almost any other detail, because it shapes your positioning, your travel restrictions and how quickly your vision clears.

Is vitrectomy considered major or minor surgery?

Neither label fits comfortably. The incisions are smaller than a grain of rice, most people go home the same day, and many have the operation while awake but sedated. By those measures it sounds minor. Yet the surgeon is working inside a single, irreplaceable organ under a microscope, and the recovery asks more of you than most day surgeries do. It is fairer to call it delicate surgery with a serious purpose.

Risks are real but, in mainstream descriptions, uncommon. MedlinePlus lists bleeding inside the eye, infection, raised pressure inside the eye, a new or repeat retinal detachment, and faster development of cataract, which is clouding of the eye’s natural lens. Cleveland Clinic makes the same point that cataract is the most frequent later consequence in people who still have their natural lens, sometimes appearing within a year or two. Your surgeon will put these in the context of your own eye during consent; no general article can do that for you.

The “major or minor” question usually hides a practical one: how much will this disrupt my life? The honest answer is that the day itself is manageable, while the first one to two weeks can be demanding if you need to hold a head position, and full visual recovery unfolds over months rather than days.

Treating it as significant helps you prepare properly. People who assume it is like a dental filling tend to arrive without a driver, without leave from work, and without anyone to open the eye-drop bottle when their dominant eye is patched.

Who is usually offered vitrectomy, and who is asked to wait?

The operation is offered when something in the back of the eye cannot be fixed from the outside. Mayo Clinic and MedlinePlus list the common reasons: a retinal detachment, where the retina pulls away from the wall of the eye; a macular hole, a small gap in the macula, the central part of the retina used for reading and faces; an epiretinal membrane, a sheet of scar tissue that wrinkles the retina; a vitreous hemorrhage, bleeding into the gel that does not clear; complications of diabetic retinopathy such as scar tissue tugging on the retina; a lens fragment dropped during cataract surgery; and severe infection inside the eye.

Timing varies enormously. A detachment threatening the macula is often treated within days. A macular hole or membrane is typically scheduled over weeks, and the discussion is about whether symptoms bother you enough to justify surgery.

Some people are asked to wait. A vitreous hemorrhage frequently clears on its own over weeks, so many surgeons observe first. Floaters alone, without a tear or detachment, are usually managed by watching, because the risks of surgery can outweigh the nuisance. Poorly controlled blood glucose, an active chest infection, or an uncontrolled blood pressure reading at pre-assessment can also push a non-urgent operation back until the body is in better shape to heal.

None of this is a fixed rule. Two people with the same scan can reasonably be advised differently based on their other eye, their job, and their ability to position afterward. The decision belongs to you and the retina team together.

Vitrectomy pre op instructions: what the assessment and surgery day involve

Most people attend a pre-operative visit a week or two before surgery. The eye is measured and rescanned, often with optical coherence tomography, a painless scan that photographs the retina layer by layer. A nurse records blood pressure, weight, allergies and every medicine you take, and asks about heart, lung and diabetes history because these shape the anesthesia plan. NHS guidance on preparing for surgery notes that you may be asked for blood tests, an electrocardiogram or a swab, depending on your health and the anesthesia planned.

You will be told which eye, what anesthesia, and what tamponade is likely. Ask for the fasting instructions in writing and for a named contact number in case something changes, such as a cold or a new prescription.

On the day, arrive as instructed, wearing something loose that does not pull over the head. Drops are given to widen the pupil and numb the surface. If you are having local anesthesia, a small injection around the eye numbs it and keeps it still; you may see light and shapes during surgery but should not feel sharp pain. Sedation makes many people drowsy enough that the hour passes quickly.

Afterward the eye is covered with a pad and a hard shield. Staff check that you can eat, pass urine and walk before discharge, and confirm your escort is present. You will be given a drop schedule, a positioning sheet if relevant, and usually an appointment for the next day or within a few days to check pressure and the retina. Keep every piece of that paperwork in one place.

Fasting before vitrectomy: why an empty stomach matters

Fasting has one purpose: keeping stomach contents out of the lungs. Under sedation or general anesthesia the reflexes that protect the airway are dulled, and vomiting can lead to aspiration, where food or acid is inhaled. A full stomach also raises the chance of nausea during and after surgery, which is unwelcome when you are trying to keep your head still.

Instructions are set by your anesthesia team, not by a general article, and they should be followed exactly. NHS guidance on preparing for an operation describes the typical pattern: no food for about six hours before, with water often allowed up to about two hours before. Chewing gum and boiled sweets count as eating in most protocols. Some teams allow clear fluids closer to the time; others are stricter. If your instructions differ from what you read online, your instructions win.

Many people are surprised to be asked to fast for surgery done under local anesthesia. The reason is that sedation levels can be deepened if you become uncomfortable, and in rare cases a local procedure is converted to general anesthesia. Fasting keeps that option safe.

Fasting does not automatically mean skipping your usual medicines. Most teams ask you to take regular morning tablets with a small sip of water unless told otherwise, and they will tell you specifically about any exception. People with diabetes should not fast on guesswork: the pre-assessment team usually provides a written plan for glucose-lowering medicines and may schedule you early in the day. If you have not been given one, call and ask before the morning of surgery.

Which medicines need review before eye surgery?

Bring a complete list to pre-assessment, including drops, inhalers, patches, supplements and anything bought without a prescription. A few categories deserve a specific conversation, and the outcome of each belongs to your prescriber and surgeon together.

Anticoagulants, which slow the clotting cascade, and antiplatelets, which make platelets less sticky, are the ones people worry about most. Stopping them lowers the chance of bleeding inside the eye but raises the chance of stroke, heart attack or clot, and for many people that trade is not worth making. Retina surgeons frequently operate with these medicines continued. Never stop them yourself; the decision is individual and depends on why you take them.

Glucose-lowering medicines, both insulin and tablets, interact with fasting. Some can push glucose too low on an empty stomach, and others are paused briefly around anesthesia for other reasons. Your team will give a written plan.

Alpha-blockers, often prescribed for prostate symptoms or blood pressure, can make the iris floppy during surgery. They are rarely stopped, but the surgeon needs to know, particularly if a cataract is being removed at the same time.

Supplements are not innocent bystanders. Fish oil, vitamin E, ginkgo and high-dose garlic have mild blood-thinning effects in some studies, and NIH Office of Dietary Supplements advises telling your surgical team about all supplements before an operation. Herbal products can also interact with anesthesia drugs.

Existing eye drops for glaucoma or dry eye are usually continued; ask which eye and whether to pause on the morning. Write the answers down. Memory is unreliable at seven in the morning with an empty stomach.

Preparing for vitrectomy at home: arranging help before the day

The single most useful preparation is a named person who can drive you home and stay with you. NHS guidance after sedation or general anesthesia is that a responsible adult should take you home and remain with you for at least 24 hours, because judgment, balance and reaction times are impaired even when you feel fine. If you will be positioning face down, that need stretches further: someone to prepare food, manage drops while you adjust to one working eye, and notice if you become unwell.

Think about the house through a patch. With one eye covered, depth perception drops, so stairs, rugs and pet bowls become hazards. Clear the route from bed to bathroom. Put a lamp within reach. Move things you use daily to waist height so you are not bending or reaching overhead.

Stock the kitchen with food that needs no chopping, and freeze a few meals. If you live alone, arrange a daily phone check with a friend for the first week and consider a pharmacy that delivers.

If positioning is planned, ask the team what equipment they recommend. Some people borrow or hire a face-down support frame or a chair with a forehead rest; others manage with firm pillows and a well-placed table. Set it up before surgery, not after, when you will be tired and half-sighted.

Finally, sort out work. Desk-based jobs can sometimes be resumed within a week or two, while anything involving dust, lifting or driving waits longer; the recovery section below has typical ranges. Tell your employer before the day so that nobody is negotiating leave from a face-down position.

What the first 72 hours after vitrectomy usually look like

Expect the eye to feel gritty, scratchy and tired rather than painful. Mild aching that eases with the pain relief your team suggests is common; escalating pain is not, and belongs in the red-flag section. The eyelid may be swollen and the white of the eye red or bruised from the anesthetic injection. Keep the shield on as instructed, particularly while sleeping, so you cannot rub the eye without thinking.

At the first check, often the next day, the pad comes off and the pressure inside the eye is measured. Pressure can rise in the early days, especially with a gas bubble, and the team will treat it if needed.

Vision in the operated eye is usually very poor at this stage and this is expected. Through a gas bubble the world looks as if you are underwater, with a wobbling dark line that gradually descends as the bubble shrinks. Through silicone oil vision is blurry and colors can look odd. Neither is a sign that something has gone wrong.

Drops start the day of or day after surgery. Most people are given an antibiotic class drop to lower infection risk and an anti-inflammatory class drop to settle swelling, sometimes with a third drop for pressure. Frequencies taper over weeks and are set by your surgeon. Wash hands, tilt the head back, pull the lower lid down and aim for the pocket, then close the eye gently. Wait a few minutes between different drops so one does not wash the other out.

Showering is generally fine with the face kept out of the spray. Hair washing is easier with help, leaning back rather than forward.

How to sleep face down after vitrectomy

Positioning exists because a gas bubble floats. If your surgeon needs the bubble to press against the macula at the back of the eye, your face has to point at the floor so that the top of the bubble sits where the repair is. Turn your face to the ceiling and the bubble drifts forward against the lens, which achieves nothing for the hole or tear and can raise pressure or hasten cataract. NHS guidance on retinal detachment surgery describes posturing as lasting several days in many cases, and your surgeon will specify exactly how many hours a day and for how long.

Not everyone is asked to position, and some are asked for a side-lying or upright position rather than face down. Follow your own sheet.

For the face-down version, a few techniques make it bearable. In bed, lie on your front with a firm pillow under the chest and a second, softer one under the forehead, leaving a gap for the nose and mouth. Some people cut a horseshoe shape into a pillow or use a travel pillow turned upside down. Sitting, rest your forehead on folded arms on a table, or on a padded massage-style face cradle if you have one. Alternate between bed and table to spare your neck.

Short breaks to eat, use the bathroom and stretch are normally built in; ask your team how long and how often. Audiobooks, podcasts and a phone propped on the floor beneath your face are the tools most people end up relying on. Neck and shoulder stiffness is common; gentle movement during breaks helps more than staying rigid.

What to avoid after vitrectomy, and why each rule exists

Most restrictions trace back to three things: the gas bubble, the fresh wounds, and the risk of infection.

Flying and high altitude are the rule people most often stumble over. Gas expands as surrounding air pressure falls, and a bubble that fills part of the eye at sea level can expand in an aircraft cabin or on a mountain road, driving pressure to dangerous levels. Mayo Clinic and MedlinePlus both state plainly that you should not fly or travel to high altitude while gas remains. Depending on the gas chosen, that can be a couple of weeks or up to around two months; ask which gas you have and check at each visit whether the bubble is gone. Nitrous oxide, a gas used in some anesthesia, causes the same expansion, so any anesthetist treating you for another reason must be told about the bubble. Many units give a wristband for this purpose.

Driving waits until your surgeon clears it, which depends on the vision in both eyes and any legal standard where you live, not simply on feeling able.

Heavy lifting, straining and vigorous exercise are generally limited for a few weeks because they raise pressure in the eye and can stress the healing wounds. Bending forward with the head below the heart is often discouraged for the same reason unless it is part of your positioning.

Water is the infection risk: no swimming, hot tubs or letting shower water hit the eye until the wounds have sealed and your team says so. Eye make-up and rubbing fall into the same category. Dusty or dirty environments, including gardening, are best postponed.

How many days should I rest after a vitrectomy? A typical timeline

Rest here means protecting the eye, not lying in a dark room. NHS guidance on recovery from retinal detachment surgery describes about two to six weeks before most people return to usual activities, with vision continuing to change for months afterward. Cleveland Clinic gives a similar picture of several weeks of restrictions with gradual improvement. The table below sketches the shape of that period; your surgeon’s plan replaces it wherever the two differ.

Stage	What is typical	Main tasks
Day 0 to 3	Poor vision in the operated eye, grittiness, shield at night, first pressure check	Drops, positioning if prescribed, someone at home
Week 1	Redness settling, bubble line visible and descending, vision still blurry	Continue drops and positioning, no driving, lifting or water in the eye
Weeks 2 to 4	Many people resume light or desk-based activity; short-acting gas often gone	Follow-up visit, ask about driving and exercise, no flying while gas remains
Weeks 4 to 8	Longer-acting gas clears; vision improving but not final	Confirm bubble gone before any flight or altitude
Months 3 to 6	Vision approaches its settled level; cataract may begin to develop	Discuss glasses update and any second-stage surgery

Two things are worth stressing. First, the visual result is judged at months, not weeks; feeling discouraged in week two is common and not predictive. Second, people with silicone oil follow a different path, because vision stays blurred until the oil is removed, usually several months later. Ask your team which timeline applies to you and write the answer on the front of your folder.

What people often get wrong about vitrectomy

“Floaters mean I need this operation.” Most floaters are harmless and are watched, not operated on. Surgery for floaters alone is offered sparingly because the risks can outweigh the benefit. New floaters with flashes or a shadow are different and need urgent assessment, not surgery on demand.

“I will see clearly when the patch comes off.” Almost nobody does. Gas, oil and swelling all blur vision for weeks, and MedlinePlus notes that full recovery of vision takes longer still. Blurriness on day one is expected.

“Blood thinners always have to be stopped.” Often they are continued, because the clotting risk of stopping can be worse than the bleeding risk of continuing. The decision is made case by case by your prescriber and surgeon, never by you alone.

“Fasting means no medicines.” Fasting refers to food and most drinks. Regular medicines are usually taken with a sip of water unless the team says otherwise, and diabetes medicines get their own written plan.

“Positioning is optional if I feel fine.” The bubble does not know how you feel. Positioning is prescribed to hold the retina in place during the first days of healing, and skipping it is one of the few things within your control that can affect the result.

“The bubble is a complication.” It is the treatment. The dark line in your vision is doing its job and will disappear on its own.

“Silicone oil is permanent.” In most cases it is removed at a planned second operation once the retina is stable, though some people keep it long term for specific reasons.

“Cataract afterward means the surgery failed.” Cataract is the most common later consequence of vitrectomy in eyes with a natural lens and is treated separately.

Questions to ask your care team before vitrectomy

Pre-assessment goes quickly, and the right questions are easy to forget. Take this list, and take a pen.

• What exactly are you repairing, and what happens if I choose to wait or not have surgery?
• Will I have local anesthesia with sedation or general anesthesia, and why that choice for me?
• What will you fill the eye with afterward: saline, gas or silicone oil? If gas, which type, and roughly how long will it last?
• Will I need to position my head? In what position, for how many hours a day, and for how long?
• Which of my medicines, drops and supplements should I continue, and which need a decision from my prescriber? Who is making that decision?
• What are my fasting times, in writing? Can I take my morning medicines with water?
• Are you planning to remove a cataract at the same time, or is that likely later?
• When can I drive, return to work, exercise, swim and fly?
• What symptoms should make me call, and what number do I use out of hours?
• When is my first follow-up, and how many visits should I expect in the first two months?
• What are the specific risks for my eye, given my other eye and my general health?

Bring someone with you if you can. Two sets of ears retain more, and the person who will help you at home benefits from hearing the positioning and drop instructions first-hand. If English is not your first language, ask for an interpreter at booking so consent is genuinely informed.

You are entitled to ask any of these more than once. A team that has done thousands of these operations still expects each patient to be doing it for the first time.

When to call your doctor after vitrectomy

Some discomfort, redness and blurred vision are part of the normal course. The signs below are not, and they warrant a same-day call to the eye unit or, out of hours, emergency care. Do not wait for the scheduled appointment.

• Pain that is severe, worsening, or not relieved by the pain relief your team suggested, especially with nausea or vomiting, which can signal a sharp rise in eye pressure.
• A sudden drop in vision compared with the day before, or a new dark shadow or curtain spreading across your sight, which can indicate a new detachment or bleeding.
• A sudden burst of new floaters or flashing lights in either eye.
• Increasing redness, a sticky or pus-like discharge, or an eyelid that becomes markedly more swollen after the first day or two. Infection inside the eye is rare but is an emergency.
• Vision that was improving and then clearly deteriorates.
• Fever, or feeling generally unwell in a way you cannot explain.
• Any head injury or fall that involves the operated eye.

Mayo Clinic and MedlinePlus both list worsening pain, vision loss and signs of infection among the reasons to seek prompt care after retinal surgery. If you are unsure whether something counts, call anyway; eye units expect these calls and would rather see a false alarm than a late presentation.

One further reminder that is easy to overlook: if you need any other operation or dental sedation while a gas bubble remains, tell that team about the bubble before anything is given, because nitrous oxide can expand it dangerously. Keep the wristband on, or write it on a card in your wallet.

Frequently asked questions

How many days should I rest after a vitrectomy?

Most people are advised to protect the eye and avoid strenuous activity for around two to six weeks, with the first week being the most restricted. Rest means no lifting, bending, driving or water in the eye rather than staying in bed. Desk-based work is sometimes resumed within one to two weeks if positioning has finished. Your surgeon sets the timeline for your eye, and it may differ if silicone oil was used.

Is vitrectomy major surgery?

It is delicate microsurgery rather than a clear-cut major or minor operation. The incisions are tiny and most people go home the same day, but the surgery is performed inside the eye under a microscope and recovery can involve days of head positioning and weeks of restrictions. Risks include bleeding, infection, raised eye pressure, repeat detachment and earlier cataract. Treating it as significant helps you prepare properly.

What should I avoid doing after a vitrectomy?

Avoid flying or high altitude while a gas bubble remains, driving until cleared, heavy lifting or straining, rubbing the eye, swimming and hot tubs, eye make-up, and dusty environments for the period your team specifies. If you have been asked to position your head, treat that as the most important rule of all. Tell any other clinician about a gas bubble before you receive any anesthetic.

How do I sleep face down after vitrectomy?

Lie on your front with a firm pillow under the chest and a softer one under the forehead, leaving a gap for breathing, or use a pillow with a cut-out or an upside-down travel pillow. During the day, rest your forehead on folded arms on a table or on a padded face cradle. Alternate positions to spare your neck and take the short breaks your team allows.

Can I eat or drink before vitrectomy surgery?

Usually not for several hours beforehand, even if you are having local anesthesia, because sedation can be deepened during surgery. NHS guidance describes a typical pattern of no food for about six hours and water permitted until about two hours before, but your surgical team’s written instructions take precedence. Chewing gum and sweets count as food. People with diabetes should receive a specific plan for fasting and medicines.

Should I stop blood thinners before vitrectomy?

Do not stop them on your own. Anticoagulants and antiplatelets reduce stroke, heart attack and clot risk, and many retinal surgeons operate with them continued because bleeding inside the eye is usually manageable. Whether to pause, and for how long, is a joint decision between the clinician who prescribed the medicine and your surgeon, based on why you take it. Raise the question at your pre-assessment visit.

How long after vitrectomy can I fly?

Only once any gas bubble has completely absorbed, which your surgeon confirms by examining the eye. Short-acting gases typically clear in a few weeks and longer-acting gases can persist for around two months. Cabin pressure lets the gas expand and can push eye pressure to dangerous levels. If saline or silicone oil was used rather than gas, the restriction is different, so ask specifically which filling you have.

Do I need someone with me after vitrectomy?

Yes. After sedation or general anesthesia a responsible adult should take you home and stay with you for at least 24 hours, because coordination and judgment remain impaired. If you have been asked to position face down, or your operated eye is your better-seeing eye, help with meals, drops and moving safely around the house is useful for several days. Arrange this before the surgery date.

Can I take my regular medicines on the morning of vitrectomy?

Most teams ask you to take your usual morning medicines with a small sip of water unless you have been told otherwise, and they will name any exceptions at pre-assessment. Diabetes medicines are the common exception and come with a written plan because fasting changes how they act. If you are unsure about any medicine, call the unit before the morning of surgery rather than guessing.

How long do you have to keep your head down after vitrectomy?

It depends on the repair and the gas used. Many people are asked to position for several days, and some for longer, often for most hours of the day with short breaks. Some repairs need no positioning at all, and others need a side-lying or upright posture rather than face down. Your surgeon will give exact hours and duration; follow that sheet rather than a general figure.

References

• MedlinePlus: Vitrectomy
• NHS: Retinal detachment
• NHS: Having an operation (surgery), preparation

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.