Cataract surgery and dry eyes

It is standard practice to treat LASIK patients for dry eye syndrome  but many doctors to not do the same for cataract surgery patients.  This is a mistake because cataract surgery patients may be in greater need of dry eye treatment than LASIK patients.  People who have cataract surgery tend to be older and have other systemic diseases that can impact the dryness of their eyes. 

Cataract surgery and dry eyes

Right now, at our Vancouver eye clinic, our largest group of dry eye patients are people who have dry eye following cataract surgery. The reason that cataract surgery results in dry eye syndrome is because the surgery cuts the nerves in the cornea of the eye. The cornea is the clear dome that goes over the colored part of the eye and it where you find the tear film that keeps eyes from drying out.

The corneal nerves are important in the the regulation of tears because they tell the brain when to produce more tears.  If these nerves are cut, like in cataract (and LASIK) surgery, the eye's ability to create a proper tear film is severely impaired. The result is dry eye.   Dry eye can cause pain, irritation and  decreased vision.

A recent study published in the American Journal of Ophthalmology set out to evaluate dry eye and meibomian gland dysfunction after cataract surgery.  Meibomian glands are the glands that produce the critical lipid layer of your tear film. If the meibomian glands are not functioning properly, your tears will not be healthy and you will likely suffer form dry eye disease.

The researchers looked at the eyes of 48 patients who underwent cataract surgery.  Their eyes were examined one month and three months after their surgery and a variety of tests were performed to test their tear quality and to test for dry eye disease. 

The researchers found that symptoms, tear quality and eye lid abnormalities were all worse following surgery. The function of the critical meibomian glands were also functioning worse after surgery.

A number of treatments are available for dry eye disease related to cataract surgery.

Dry eye and visual acuity

It is important to realize that dry eye is not just about pain, irritation, dryness and the like.  It is also about clear vision.  One way of diagnosing dry eye disease is to measure a patient's visual acuity and then to apply artificial tears and immediately measure acuity again. If the patient's vision improves after the artificial tears, it probably means that there was insufficient tear film initially.

Cataract patient management for dry eye

So what do we do about this problem?  At our clinic we believe that it is important to get ahead of the problem and to begin dry eye treatment before surgery so that the patient's discomfort and visual loss following cataract surgery is minimized.  The best defense against dry eye following cataract surgery is a good offence. There are many different treatments available and the same treatment is not appropriate for every patients.  If you are about to have cataract surgery, you should go see your optometrist about pre and post operation management.

Be aware that dry eye leads to other problems.

Dry eye is not only uncomfortable and painful, it can also lead to other problems, such as problems with driving, and depression and anxiety. That's why it is a good idea to seek treatment immediately. 

Pre-surgical care

Another effective technique to manage dry eye following cataract surgery is to be pro-active and to use prescription dry eye medications prior to dry eye in an effort to reduce or prevent the pain and discomfort of postoperative dry eye.