Eye procedures are considered to be low risk; however, many ophthalmic surgery patients are elderly and are a unique vulnerable group with a myriad of concomitant health issues that put them at greater risk for perioperative medical complications. A trend to shift operative venues from hospitals to ambulatory facilities and more recently to specialty eye-care surgery centers limits the resources available to manage major, and even minor, medical issues that arise on the day of surgery. The role of the internist in the preoperative evaluation and optimization of medical issues before surgery and availability for perioperative consultation and intercession is increasingly essential.