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Cataract Surgery And Dry Eyes

The Background Of Ded

Dry eyes following cataract surgery: Explained

DED is a complex disease process and this is highlighted by the lack of a globallyagreed definition, which may perhaps explain the variation in data relating to DEDin the existing literature.57 DED is defined by the Tear Film and Ocular Surface Society Dry Eye WorkshopII as

a multifactorial disease of the ocular surface characterized by a loss ofhomeostasis of the tear film, and accompanied by ocular symptoms, in whichtear film instability and hyperosmolarity, ocular surface inflammation anddamage, and neurosensory abnormalities play etiological roles.6

The definition by Asia Dry Eye Society24 states that dry eye is a multifactorial disease characterized by unstabletear film causing a variety of symptoms and/or visual impairment, potentiallyaccompanied by ocular surface damage, while the Korean Corneal Disease Study Groupdefines DED as a disease of the ocular surface that is associated with tear filmabnormalities, where patients have at least one clinical sign and symptom for diagnosis.25 Although the overlap between the various definitions can be appreciated, thislack of consensus demonstrates the complex nature of DED.26

DED is clearly a common condition with significant effects on the QOL of patients andassociated economic costs.6,28,3238,46 The effective treatment of DED both prior to and following cataract surgeryis important in ensuring that patients receive optimal care.6,47,48

Do All Patients Get Dry Eye Syndrome After Cataract Surgery

In my practice, about a quarter to a third of patients experience dry eyes after undergoing cataract surgery. For almost all of them, their dry eyes are very light on the spectrum of how irritating dry eyes can be.

For those who already had dry eyes before their cataract surgery, they will continue to experience the symptoms if they dont use their eye drops after surgery.

The Pathophysiology Of Cataract Surgery Associated Ded

While the published evidence shows inconsistencies, probably due to the discordancebetween DED symptoms and signs,44,45 as well as the variability of current DED assessment methodologies, thereclearly is an association between cataract surgery and both development ofiatrogenic DED and exacerbation of pre-existing DED.718,4751 As discussed, disruption in tear film homeostasis is a key component in thepathogenesis of DED and there are a number of possible intra- and post-operativefactors in modern phacoemulsification cataract surgery which can disturb thetear film milieu.6 These factors appear to include incisional corneal nerve injury and ocularsurface damage from the toxic effects of components of eye drops ocular surfacedrying/repeated irrigation phototoxicity and surgical trauma .

Pathophysiology of intra-operative factors in cataract surgery contributingto DED.

FLACS: Femtosecond laser-assisted cataract surgery FL: Femtosecond laser NSAIDS: Non-steroidal anti-inflammatory drugs.

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Postoperative Assessment And Treatment

Following your cataract surgery, the doctor will perform tests to make sure the operation was successful, and to determine whether you are at risk of dry eye symptoms. Similar to preoperative assessments, these tests may involve the use of specialized dyes to detect any issues on the cornea or the ocular surface. Additionally, you might be asked to fill out surveys to help the doctor gauge any symptoms you may be experiencing. Examples of such surveys include the Standard Patient Evaluation of Eye Dryness or the Ocular Surface Disease Index surveys.

Topical artificial tears are commonly suggested as a treatment option for people with dry eye after cataract surgery. There are a variety of tear formulations available, for patients with particularly sensitive eyes or other issues that may make standard artificial tears ineffective or unsafe.

What If My Dry Eyes Feel Worse After Cataract Surgery

The Relationship Between Dry Eye and Cataract Surgery

Many people experience dry eyes for the first time after cataract surgery. Dont worry, this is normal.

Most people need to use prescription eye drops after having cataract surgery. These will help to relieve the pain and discomfort of dry eyes. If you have suffered from dry eyes in the past, you might need to use the eye drops for longer.

It is important to listen to your doctors recovery advice after the surgery. If not treated, dry eyes can lead to bothersome symptoms.

Your eyes may not heal properly. Always be honest with yourself and your doctor about what you are feeling. That way, you can solve the problem together.

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Technique And Details Of Cataract Surgery

Figure 2. Techniques of cataract surgery used in different etiologies of dry eye disease. The donut graph shows the distribution of various techniques of cataract surgery in the entire cohort and in different etiologies of dry eye like cicatrizing conjunctivitis , meibomian gland disease , and Sjogren’s syndrome . Phacoemulsification is the most common technique of cataract surgery performed in all the three groups and also in the entire cohort.

Why Factor Dry Eye Into Cataract Surgery

Ophthalmologists who perform cataract surgery are giving dry eye more attention nowadays. There are a few reasons for this, including:

  • Cataract surgery can lead to an increase in dry eye symptoms. These symptoms may be uncomfortable.
  • Dry eye can affect results from cataract surgery. You may not see as well as you could if you did not have dry eye.
  • Dry eye can affect calculations for an intraocular lens . This is the artificial lens placed in your eye once the eye doctor removes your original lens. This could lead the surgeon to use an IOL that is less than ideal for your eyes.

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Cataract Surgery Side Effects And How To Cope

Cataract surgery is a safe procedure that improves vision for the vast majority of people. Serious complications are rare among the 4 million U.S. cataract patients who have surgery each year.

Although the recovery process is different for everyone, there are some issues that people commonly encounter in the days after surgery, as the eyes heal.

Here are 10 problems you might experience after cataract surgery, why they occur and what to do about them.

Incisional Corneal Nerve Damage

Lifitegrast in Dry Eye Patients Undergoing Cataract Surgery – Video abstract [ID 264520]

In laser kerato-refractive surgery the treatment of pre-existing DED, exclusionof patients with intractable DED and the routine use of post-operativelubricating drops are consistently undertaken to minimize DED due to cornealnerve damage induced during procedures such as laser in situ keratomileusis and photorefractive keratectomy ,5254 with patients being warned and consented pre-operatively of theoccurrence of such problems. However, damage to radial corneal stromal nervesinflicted as a result of full-thickness incisional wounds in cataract surgeryand subsequent disruption of tear film homeostasis51 do not appear to be fully appreciated.55

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What To Expect From Dry Eyes After Cataract Surgery

Dry eye after cataract surgery may be temporary, lasting just a couple of months.

However, if you had dry eye before cataract surgery, you may continue to have related symptoms beyond these initial months. You also may need to continue any treatments for dry eye that you used before surgery.

Your eye doctor may make certain changes during the cataract surgery to lower your chance of experiencing dry eye. These include using:

  • Smaller incision sizes when possible
  • A special type of solution on the eye during surgery called a dispersive ophthalmic viscosurgical device
  • A lower amount of surgical light exposure if possible
  • Careful handling of the tissue in the eye

Treatment For Your Dry Eyes

There are several treatments for dry eyes after cataract surgery. The most common of these treatments is artificial tears.

This is a specific type of eye drop that provides relief to dry tear ducts. Your doctor might also recommend using fortified eye drops which soothe the eye.

If you are still experiencing dryness, there are other options. Your eye doctor may recommend lubricating gels and ointments that can further soothe the eye. In some cases, more powerful medicines like steroids and Restasis can be useful.

Most eye doctors recommend getting ahead of dry eyes after surgery. Even if you do not have dry eyes immediately after having cataract surgery, eye drops can keep your eyes from becoming too dry.

Artificial tears and fortified eye drops can only help your eyes, so dont be shy about taking them. Dry eyes can be annoying after cataract surgery.

Most people will experience this symptom in some way following surgery. Luckily, treatment of this has improved in recent years.

Make sure to stick to the medications given to you by your doctor. Let them know if anything feels strange, or painful. Soon, youll no longer have cataracts with dry eyes and be able to see clearly once again!

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Whats The Treatment For Post

Post-operative antibiotic drops are given to patients after surgery to stop infection and inflammation from occurring. If you experience dry eye despite taking these drops and its causing you a lot of discomfort, you can get over-the-counter lubricant drops and use them usually three to four times a day maximum.

It is very important that you wait until at least 10 minutes after youve inserted your prescribed post-operative antibiotic drops before inserting the over-the-counter drops. This is to allow your cataract surgery drops to be fully absorbed.If you do it in reverse order or dont wait long enough, the cataract drops may bounce off the surface of your eye and wont be absorbed.

Ocular Surface Damage Due To The Toxic Effects Of Eye Drops

Clinical trial on patients undergoing cataract surgery.

The use of eye drops during and after surgery may lead to potentially harmfuleffects on the ocular surface with injury to corneal epithelial and conjunctivalepithelial and goblet cells. Li et al.63 investigated 37 patients before and up to 3 months after surgery anddocumented DED after surgery in most, with the presence of conjunctivalepithelial squamous metaplasia on impression cytology, especially in the regionof the lower lid. They suggested that the peri-operative use of eye drops is oneof the major pathogenic factors causing DED after cataract surgery.63

While the immediate pre-operative use of povidone-iodine has been shown to beimportant in reducing the risk of post-operative endophthalmitis,64 laboratory studies have demonstrated its potentially toxic effects on thecorneal surface.65,66 Similar changes have been shown with the administration of topicalanaesthetic drops.67,68 The type and volume of such drops should therefore be carefullyconsidered, especially in eyes with pre-existing DED/OSD.

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Demographics And Etiology Of Ded

The median age of DED patients undergoing cataract surgery was 58 years . Among the 399 cases, 265 and 134 were females and males, respectively. Of the 668 eyes included in the study, CC was the most common cause of DED seen in 279 eyes followed by MGD and SS, which were seen in 255 and 134 eyes, respectively. Of the 279 eyes with CC, StevensJohnson syndrome was the leading cause seen in 209 eyes followed by ocular cicatricial pemphigoid and graft-versus-host disease in 59 and 1 eye. The cause of cicatrization was unknown in 10 eyes. Among the 134 eyes with SS, primary and secondary SS was diagnosed in 19 and 115 eyes, respectively.

Can Having Dry Eyes Stand In The Way Of Cataract Surgery

May 29, 2020

Cataracts are a common eye condition in adults over the age of 40. Cataracts can also severely affect your vision.

They develop slowly but they can eventually make it almost impossible to see. When fully developed, they even cause total blindness.

The good news about cataracts is that their visual constraints dont have to be permanent. Thanks to cataract surgery, you can regain your vision and have your cataracts removed.

Cataract surgery is also the only effective treatment option for cataracts. Like any surgical procedure, there are risks that come with having cataract surgery.

While cataract surgery is a safe procedure, having pre-existing conditions can make it a little more difficult. This includes if you have conditions like dry eye syndrome.

Keep reading to learn if having dry eyes can stand in your way of having cataract surgery!

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Inclusion And Exclusion Criteria

Articles that met the following criteria were included: all the subjects were patients with dry eye after phacoemulsification combined with intraocular lens implantation the control group received conventional anti-inflammatory treatment the intervention group was treated with sodium hyaluronate eye drops plus the conventional treatment the study was carried out in Chinese populations the design was a prospective randomized controlled trial and all patients were treated for 1 month.

The outcome indicators include any of the following: total effective rate, dry eye symptom score , tear film break up time , fluorescein score , and Schirmer I test .

The exclusion criteria were the following: suffering from dry eye, glaucoma, diabetes, and other conditions before surgery a retrospective design animal experiments, reviews, case reports, comments, abstracts, and other types of articles use of Chinese medicine during the treatment and inadequate data. Articles that were published both in Chinese and in English were included as well as those studies with the most comprehensive data.

Dry Eye After Cataract Surgery

Did cataract surgery cause my dry eyes?

The quality of your tear film is an important consideration after you undergo cataract surgery. High-quality tears to keep your eyes moist and healthy will help the healing process.

Additionally, people who struggle with dry eye before cataract surgery are more likely to have optical aberrations, which can make fitting an intraocular lens harder. After cataract surgery, dry eye may become worse.

It is important to know that dry eye is common after eye surgeries involving lasers, like LASIK or cataract removal surgeries. This side effect usually goes away after about six months on its own.

As long as you keep your eyes lubricated with appropriate eye drops, you should not experience damage to your eye, and the condition will clear up. However, for 10 to 30 percent of people who develop dry eye after laser surgery, the condition persists beyond this timeframe.

Undiagnosed dry eye can make ocular surface disease worse. If your eyes are too dry, the surface of the cornea can become scratched, which may cause an infection or lead to scarring of the cornea. This will eventually decrease your vision, making it blurry or foggy, similar to some of the initial symptoms of a developing cataract.

One study reported that few patients complained about dry eye before undergoing cataract surgery, but about 80 percent of them had signs of dry eye in tests prior to the operation.

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Eye Surgery And Dry Eyes

What to expect before and after surgery

Most people experience dry eyes after cataract surgery and after LASIK surgery , as well as eyelid, glaucoma, retina, cornea or squint surgeries. In fact, studies show that 95% of people who underwent LASIK surgery and more than 87% of people who underwent cataract surgery had symptoms. The good news is, for most people, symptoms improve after a few months and are usually gone by 6 12 months. 48 You also have plenty of options to find relief while youre going through it.

Why To Use Artificial Tears Postoperatively

Many patients over the age of 55 complain that their eyes occasionally water, burn, itch, or feel scratchy or heavy. These dry eye symptoms are not serious however, they are annoying and irritating. Although it sounds contradictory, the most common cause of sudden watering and tearing is an unstable tear film momentarily producing a dry eye surface. When we are awake, our upper and lower eyelids only cover part of the eyeball surface. The rest of the surface is exposed to the environment all day long. Potential irritants include dust, pollen, smog, smoke, wind, and sunlight. Protecting our exposed eye surface from these elements is a thin layer of oily fluid, called the tear film. This also lubricates the eye surface . The purpose of blinking is to constantly spread a fresh tear film over the eye surface.

With age, the quality of the tear film diminishes and it tends to evaporate more easily. Small dry spots form, and these exposed areas of the eye surface become slightly irritated. This may cause a reflex watering to occur. These watery, runny tears rinse the eye surface, but do not lubricate it. As an analogy, water rinses our mouth, but does not coat and lubricate the inside of our mouth in the way that saliva does. Likewise, taking a shower does not lubricate dry skin, but instead washes off the natural skin oils. Water is wet, but makes our skin even drier.

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Why Do I Have Dry Eyes After Cataract Surgery

There are several reasons why you may have dry eyes after cataract surgery. These include:

  • Changes to your tear film surface: These can be caused by the incision, or cut, made during surgery.
  • Certain eye medications: After cataract surgery, your doctor will likely want you to use certain eye drops to help your eye heal and prevent infection. These may include antibiotics and steroid drops. The ingredients in these drops sometimes can irritate the eyes and cause dry eye symptoms.
  • Lowered mucin production from the conjunctiva due to the surgical incision: Your conjunctiva is a clear covering of the eye’s front surface. Your conjunctiva may produce less of a protein called mucin after cataract surgery. Mucin helps to hydrate the surface of the eye.
  • Lower tear film production: This can be caused by surgically induced ocular inflammation and exposure to light from the surgical operating microscope.
  • The type of intraocular lens used: An intraocular lens, or IOL, is what an eye surgeon will place in the eye after removing your natural lens. One newer group of IOLs is called multifocal IOLs. These IOLs cost more than a standard IOL. Some of the newer multifocal IOLs are associated with higher incidences of dry eye.
  • Having preexisting dry eye: Nowadays, many eye doctors will try to diagnose and treat dry eye before cataract surgery. Still, it’s possible for dry eye to go undiagnosed pre-surgery. Symptoms may emerge more strongly after surgery.

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