Couching is an ancient cataract treatment technique that involves dislodging the clouded crystalline lens from the visual axis to clear the cataract. It's the earliest recorded surgical cataract treatment method, and ancient drawings inside Egyptian temples and tombs illustrate the use of couching surgical instruments. The earliest written account of the procedure was made in 800 BCE by an ancient Indian surgeon, Maharshi Sushruta. His treatise, the "Sushruta Samhita, Uttar Tantra," describes the treatment, where a surgeon uses a needle to force the cataractous lens towards the back of the eye. Then, the doctor would apply clarified butter on the patient's eye and bandage it.

Evidence indicates that the technique was widely practiced in Asia, Europe, China and Africa until the C19 AD. After this period, it fell out of fashion in the West and gradually in other parts of the world after scientific and technological advances in cataract surgery. Thus, the procedure paved the way for the development of modern cataract surgery, including pars plana vitrectomy. However, the method is still practiced in some remote regions of the world, especially in Africa and parts of Asia, including India, Nepal and Tibet.

Also Known As

  • Couching eye surgery


Before the Procedure 

The treatment was typically conducted on mature cataracts. The eye surgeon would take the patient's history and perform an eye examination, which included a check for visual acuity. In some cases, the patient would be given an oily massage and some heat bath.


The patient would be escorted into an operation theater room with a high stool, couch, or a piece of carpet on the floor. The surgeon would take his position and begin the operation by stabilizing the patient's eye with his thumb. He would then use a sharp instrument like a needle, horn, or thorn to puncture the eye at the cornea's edge, the clear front part of the eyeball.

The tip of the surgical instrument would pierce the lens capsule, and with forward rotating movements, the surgeon would dislodge the clouded lens and push it into the vitreous cavity. It enabled light to get into the eye, and once the patient could detect movement or shapes, the operation ended. The procedure took out the eye lens, and the patient would need a powerful prescription lens for a clear vision.

The surgeon had to take precautions not to damage blood vessels in the area. If the piercing was followed by bleeding, it meant that it was misplaced.

Risks & Complications

The lack of antiseptic and the retained cataractous lens had harmful effects on the eye, often causing blindness shortly after the treatment. Other risks included:

  • Phthisis
  • Eye infection
  • Corneal edema
  • Endophthalmitis
  • Swelling of the iris
  • Vitreous hemorrhage
  • Cystoid macular edema

The side effects included pain, tearing and feeling of a foreign object in the eye due to the wound on the cornea.

Some of the complications associated with the treatment include:

  • Optic atrophy
  • Retinal detachment
  • Secondary glaucoma


After Care & Recovery

The surgeon would smear some traditional medicines on the eye, bandage it, and instruct the patient to go home and lie on their back. The patient was to avoid any movement, particularly coughing and sneezing. The doctor would follow up daily until the tenth day, and if there appeared a whitish matter in the pupillary area, the treatment would be repeated.


The treatment method had poor results, with over 70 percent of the patients going blind.