MGD leads to different dry eye symptoms after cataract surgery
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An investigation into dry eye symptoms after cataract surgery in patients with meibomian gland dysfunction showed different changes to the ocular surface and damages to the epithelial function between early and late postoperative phases compared with common cataract patients.
“We believed that changes in the early postoperative phase to the ocular surface were caused by surgical factors, and for MGD patients with cataract surgery, changes in the early postoperative phase to the ocular surface were caused by surgical factors, and the damages to epithelial function in the later postoperative phase were mainly associated with the inflammation of the meibomian gland and eyelid; thus, MGD would have aggravated the development of dry eye,” the researchers wrote in the study published in International Ophthalmology.
The researchers divided 115 patients (115 eyes) with age-related cataract into either an MGD diagnosis group or a control group. They performed Schirmer I test (ST-I), tear breakup time (TBUT) and corneal fluorescein staining (CFS) preoperatively and at 3 days, 7 days, 14 days and 30 days postoperatively, along with meibomian gland morphology and expression and meibum character scores.
Postoperative TBUT was shorter than preoperative in both groups (P < .01); however, TBUT was less in the MGD group than the control group (P < .01).
ST-1 results increased at 3 days and 7 days postop in both groups, then decreased gradually at 14 days and 30 days. At 30 days, ST-1 was significantly different compared with preoperative results in both the MGD (10.93 vs. 13.61 mm) and control group (10.15 vs. 12.89 mm). This change was not different between the groups.
CFS scores were higher in the MGD group compared with controls at each time point after surgery (P < .01), although the control group also had significantly increased CFS scores after surgery. Both groups showed decreases by 14 days and 30 days.
The researchers determined that MGD correlated positively with TBUT and CFS results postoperatively (P < .01).
For the patients with MGD, postoperative eyelid margin morphology scores at different times increased significantly with time, the main manifestations of which were increased blood capillary hyperemia of the eyelid margin and aggravated eyelid edge swelling. Results also showed that meibum secretion and meibum characteristic scores increased postoperatively, although these results were not statistically significant.
“Providers should pay attention to the treatment of MGD in patients with dry eye after surgery, except for artificial tears without preservatives and hormone anti-inflammatory treatment,” the researchers concluded. “Before the operation, the patient’s meibomian gland function should be carefully evaluated; the intervention and treatment of MGD may effectively reduce the occurrence of dry eye.” – by Talitha Bennett
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Catherine Hogan, OD, FAAO
The practicing optometrist must investigate beyond the diagnosis of dry eye disease for compounding etiologies, including MGD. This prospective study compared TBUT scores, Schirmer I test results, corneal fluorescein staining, morphology and function of meibomian glands in MGD patients vs. controls before and after cataract surgery. Postoperative results were clinically significant for reduced TBUT scores, increased corneal fluorescein staining and increased eyelid margin hyperemia in MGD patients compared with controls. The report concluded that early postoperative ocular surface disruption was induced by surgical factors, including epithelial manipulation and eyedrop instillation, and later postoperative findings were largely associated with MGD’s inflammatory cascade.
Study limitations include nuances of surgical protocol (standard blade incision, postoperative drop regimen) and duration. Anterior segment assessment beyond 30 days would better investigate chronic complications of MGD.
The importance of MGD evaluation during comprehensive examination and not solely prior to surgery referral is emphasized. The optometrist must assess ocular surface integrity, including meibomian gland structure, meibum expression and meibum quality. Meibography technologies allow practitioners to assess for structural compromise; practitioners without imaging capabilities should perform transillumination at the slit lamp to visualize meibomian gland abnormalities. Further, clinicians should tangibly monitor patient symptoms with collective Ocular Surface Disease Index reports.
It is the clinician’s responsibility to educate MGD patients regarding their chronic inflammatory condition and initiate appropriate treatment. The optometrist must discuss cataract surgery options best suited for the individual patient, considering cataract type, density, and systemic and ocular comorbidities.
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