Dry eye disease or simply DED is an illness that can lead to chronic ocular surface dysfunction due to tear film instability, hyperosmolarity, chronic inflammation, and neurosensory abnormalities. It may also deteriorate after cataract surgery, leading to an increased risk of complications and poor visual outcomes.

This is most likely owing to increased inflammation, eye drop toxicity, and limbal incision-induced corneal nerve injury. Studies have linked cataract surgery to an increased risk of this disease, as well as the latter triggering pre-existing conditions. As a result, it’s not uncommon to have to deal with both dry eye and cataract problems.

This emphasizes the importance of comprehending the numerous factors that influence cataract surgery outcomes in eyes with pre-existing dry eye traits.  Cataract patients with Dry eye characteristics, in either case, must be fully educated about the hazards of dry eye linked with cataract operation, such as visual fluctuations and blur.

Signs and Symptoms Evaluation

Given that the association between the signs and symptoms of dry eye disease is faint, the ocular surface disease is frequently ignored during the preoperative cataract evaluation. Even in cataract patients with the tiniest suspicion of such conditions, a full history and ocular examination, as well as a battery of clinical testing, should be done and documented.

An authenticated dry eye questionnaire, such as the Standard Patient Evaluation of Eye Dryness or the Ocular Surface Disease Index, should be utilized to acquire a comprehensive ocular history from each patient before surgery.

Objective Tests

Numerous novel noninvasive tests for assessing DED have been developed, including osmolarity analysis and lipid layer interferometry. When the signs and symptoms of DED are present, and tear osmolarity testing is positive, the Schirmer test can be used to diagnose aqueous-deficient DED. 

Ocular Surface Analysis

DED treatment should be individualized based on the severity of the disease. Artificial tears and environmental management are frequently sufficient treatments for mild to moderate dry eye.

In cases of suspected nocturnal exposure, artificial tear ointment or gel, used right before night, is a beneficial complement to artificial tear therapy.

Conclusion

In certain circumstances, DED treatment can postpone cataract surgery, but it is usually a good investment. Although DED is not a complete contraindication to cataract surgery, it should be treated aggressively before the procedure.

Because cataract surgery has been proven to cause or exacerbate preexisting DED, clinicians should be on the lookout for the syndrome while evaluating cataract patients, plan surgery accordingly, and actively treat the condition both before and after surgery.