Treat dry eye before ocular surgery to avoid postoperative problems
Key takeaways:
- Many patients do not know that they have dry eye disease.
- Dry eye can lead to higher-order aberrations that cause image defocus and distortion.
KOLOA, Hawaii — Aggressive treatment before ocular surgery helps avoid postoperative issues with visual quality in patients with dry eye disease, according to a speaker at Hawaiian Eye 2025.
Preeya K. Gupta, MD, said there are a lot of reasons why people may have dry eye disease, but ocular surgery, whether LASIK or cataract surgery, is a big culprit.
“It is because of this temporary disruption to the corneal nerves that patients sometimes go from being asymptomatic to symptomatic after surgery,” she said.
Gupta said dry eye is common in patients even before they undergo surgery. In a study she helped conduct, 80% of patients who were scheduled to undergo cataract surgery had at least one abnormal test that suggested ocular surface dysfunction.
“Our patients are showing up with dry eye disease and often don’t know it,” Gupta said. “But they do know that they have visual complaints.”
Gupta said postoperative reduction in visual quality is the main reason to address this issue. Dry eye can lead to higher-order aberrations that cause image defocus and distortion, which can be difficult to correct with glasses or contacts. This can lead to patients who are unhappy with their surgery even if they have 20/20 vision, she said.
In her practice, Gupta said she aggressively treats any ocular surface disease before surgery, which can help lead to better visual quality and happier patients.
The first step is finding these patients. Gupta uses a variety of diagnostic tools, including tear stability assessments, osmolarity tests, vital dyes and meibomian gland imaging, to guide her preoperative treatment.
While there are many treatments available for ocular surface disease, Gupta said topical steroids are her go-to choice.
“I use topical steroids in pretty much all of these patients as a brief pulse so that they can rapidly rehabilitate any corneal staining,” she said. “If they are in that long-term bucket, I add a topical immunomodulator.”
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Gupta PK. Post-operative patients & the tear film: Why patients with DED don’t see well. Presented at: Hawaiian Eye 2025; Jan. 18-24, 2025; Koloa, Hawaii.
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