A lot of people who have had cataract surgery complain of dry eye syndrome (DES). This is unsurprising, considering how cataract surgery is performed. It is very important, therefore, that patients are made aware of this and are given proper methods of treatment after the surgery. Some experts now suggest that dry eye treatment should even start before the surgery itself, although research still has to be completed on this.
Cataract surgery involves cutting through the corneal nerves, whether it is through the use of a laser or a microkeratome. Almost all patients experienced DES after this type of surgery, so much so that DES treatment for a few months afterwards is now standard.
Seventy-three percent of cataract surgery is now clear corneal cataract surgery. This procedure cuts quite a large part of the corneal nerves, and these nerves are essential to the natural production of tears. When this is disrupted in any way, the eyes will struggle to create a suitable tear film, leading to dryness and, possibly, decreased visual function.
The tear film has to be healthy in order to have optimal vision. This is something that cataract surgeons must also take into consideration. It is now recommended that they complete a tear normalization test to determine whether dry eye is already present or not. Patients, nowadays, have high expectations of surgical procedures. As such, they believe that their vision will be fine after their cataracts are removed. It is important that they are aware of any DES already present, and what they must do to prevent it.
Most patients who have had cataract surgery complain of feeling as if there is a foreign body in their eye. For years, surgeons believed this symptom to be due to the incisions made on the eye. However, these feelings often continued for very lengthy periods of time, which would suggest that it is actually down to something else. Nowadays, it is known that this sensation is indeed caused by Dry eye syndrome. Most of the time, these feelings subside once the corneal nerves have regenerated.
There are a number of factors that increase the chances of someone developing DES after cataract surgery. These include:
- The surgery itself, which can lead to ocular inflammation
- Post-surgical medication, which can be a diuretic
- Fluoroquinolones used during cataract surgery, which have been proven to cause tear film disruptions.
How DES After Cataract Surgery Is Treated
There are a number of treatment options available for people who experience DES after cataract surgery. The table below highlights some of the differences between these.
|Type of Treatment||Example Names||Details||Cons|
|Artificial tears||Given to almost all cataract patients after surgery||Short-lived effects. Aggressive dosing required. If they contain preservatives, they can cause further damage.|
|Fortified artificial tears||Sooth||This restores the lipid layer of the tear through lubrication. Helps to restore the layer of lipid in the tear and sooths the ocular surface.||Doesn’t last very long.|
|Fortified artificial tears||Systane, Nanotears||This is a gel-type lubricant. It stops tears from breaking up too quickly and provides long lasting relief.|
|Lubricating gels and ointments||Can blur vision.|
|Anti-inflammatory gels and ointments||Steroids||Not often suitable as most cataract patients already have to take steroids.|
|Anti-inflammatory gels and ointments||Restasis||Not often suitable as most cataract patients already have to take steroids.|
|Blocks of tear drainage||Punctal plugs||Excessive form of treatment unless absolutely needed.|
|Systemic treatment types||Oils||Omega 3 oils and flaxseed oils have proven to be particularly effective.|
|Doxycycline||Recommended if blepharitis is diagnosed.||Excessive form of treatment unless absolutely needed.|
Treatment After Cataract Surgery
Because it is now so well-known that people suffer from DES after cataract surgery, most surgeons will now offer DES treatment as standard as well. This can help to keep DES at bay, as well as ensuring people are happier with the results of the procedure.
It is very common for patients to have to take antibiotics for a week after their surgery, following by topical steroids for a further four weeks. Depending on the surgeon’s preference, some of the treatments described in the table above may also be used. Usually, patients will have to come back for follow-up appointments, where the effectiveness of the DES treatment can also be discussed.
Cataract surgery is advancing quite rapidly, which means it is also becoming better and more effective. It is hoped that, soon, it will not lead to DES anymore, although this isn’t likely yet. For patients, what matters is that their vision is restored and if they suffer post-operative DES, they may feel as if the entire produced was unsuccessful, even if this is not the case. As such, it is very important that a surgeon discusses the potential for DES with their patients before the procedure.
Unfortunately, some research now also suggests that DES may affect the visual outcomes after cataract surgery. This is particularly true if DES was already present in the patient. This is further reason why it is vital that surgeons perform a full pre-operative examination and treat any underlying conditions before the surgery is performed. It will also enable them to make better decisions in terms of where to make incisions in the eye of the patient.
Resources and References:
- Cataract Surgery Recovery – Information on recovery after cataract surgery. (All About Vision)
- Dry Eye Syndrome and Cataract and Refractive Surgery – Connection between dry eyes and cataract and refractive surgery. (EyetubeOD)
- Incidence and Pattern of Dry Eye after Cataract Surgery – Dry eye after cataract surgery. (PLOS One)
- Dry Eye after Cataract Surgery and Associated Intraoperative Risk Factors – Risk factors for dry eyes after cataract surgery. (NIH.gov)