PURPOSE: To determine the rate and risk factors for new persistent opioid use after ophthalmic surgery in the United States (US). DESIGN: Retrospective claims-based cohort analysis. PARTICIPANTS: Opioid-naive patients aged 13 years and older who underwent incisional ophthalmic surgery between January 1, 2012 to June 30, 2017 in Optum’s de-identified Clinformatics® DataMart Database. METHODS: New persistent opioid use was defined as fulfillment of an opioid prescription both in the 90 day and the 91–180-day periods following the surgical procedure. The primary explanatory variable was an initial perioperative opioid prescription fill. The rate of new persistent opioid use was calculated, and multivariable logistic regression models were used to identify variables that increased the risk of new persistent use and refill of an opioid prescription after the initial perioperative opioid prescription in the 30 days after surgery. MAIN OUTCOME MEASURES: New persistent opioid use and refill. RESULTS: A total of 327,379 opioid-naive patients (mean [SD] age, 67[16] years; 178,067 [54.4%] female) who underwent ophthalmic surgery were examined. Among these patients, 14,841 (4.5%) had an initial perioperative opioid fill. The rate of new persistent opioid use was 3.4% (498 out of 14,841 patients) in patients having an initial perioperative opioid fill compared to 0.6% (1833 out of 312,538 patients) in patients without an initial perioperative fill. After adjusting for patient characteristics, initial perioperative opioid fill was independently associated with an increased odd of new persistent use (adjusted OR 6.21; 95% CI, 5.57–6.91; p=150 morphine milligram equivalent (MME) was associated with an increased odd of refill (adjusted OR 1.87; 95% CI, 1.58–2.22; p