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Dry eye may heavily affect results and quality of life following cataract surgery

Issue: October 10, 2016

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COPENHAGEN — Dry eye following cataract surgery can be a distressing, unresolved problem that might heavily affect the visual outcomes of the procedure, according to a specialist speaking at the European Society of Cataract and Refractive Surgeons meeting.

The pathophysiology may include, and often combine, corneal sensitivity impairment, inflammation and goblet cell loss, as well as meibomian gland dysfunction (MGD). Corneal sensitivity impairment is due to disruption of the sensory nerves by surgical incisions and may last for up to 3 months after surgery. Reduced sensitivity leads to reduced tear production and aqueous deficiency dry eye, Rita Mencucci, MD, said.

“Incision shape also plays a role. Foreign body sensation and dry eye symptoms may be caused by a grooved incision, the epithelial gap and stretching of the incision,” she said.

Evaporative dry eye may be related to post-cataract inflammation and goblet cell loss due to a combination of factors, which may include anesthetics and medications, thermal energy, manipulation and light exposure. Femtosecond laser cataract surgery carries an even higher risk of dry eye due to suction and the femtosecond incision.

Cataract surgery may also alter meibomian gland function or exacerbate pre-existing MGD.

“Identifying patients with pre-existing dry eye, including MGD, as well as other at-risk patients, such as diabetic patients, is mandatory,” Mencucci said.

The tear film contributes two-thirds of the refractive power of the eye. An uneven surface due to tear film instability heavily affects quality of vision, reading speed and contrast sensitivity.

“It also affects biometric accuracy, which is particularly important with the premium IOLs we use today,” Mencucci said. – by Michela Cimberle

Reference:

Mencucci R. Dry eye after IOL procedures. Presented at: 34th Congress of the European Society of Cataract and Refractive Surgeons; Sept. 10-14, 2016; Copenhagen, Denmark.

Disclosure: Mencucci reports no relevant financial disclosures.