Optimizing therapy for dry eye disease (keratoconjunctivitis sicca, also known as dysfunctional tear syndrome) before cataract surgery improves visual outcomes. This can be especially important in patients who desire excellent refractive outcomes with the placement of premium intraocular lenses (IOLs), such as toric and multifocal lenses. There are numerous aqueous-layer supportive treatments, allowing for customization to the patient, including
topical preserved and nonpreserved liquid tear preparations, gels, and ointments
topical cyclosporine or lifitegrast
For additional detail on dry eye therapy, see BCSC Section 8, External Disease and Cornea.
During the procedure, the surgeon can prevent desiccation of the corneal epithelium by frequently hydrating the area with irrigating solution or by coating the cornea with a topical ophthalmic viscosurgical device (OVD). Visual recovery may be delayed if the dry eye condition is exacerbated; for such patients, preoperative or postoperative placement of punctal plugs can be helpful.
Patients with dry eyes associated with collagen vascular disease, rheumatoid arthritis, Sjögren syndrome, mucous membrane pemphigoid, or Stevens-Johnson syndrome present a special challenge to the cataract surgeon. Close observation of these patients in the weeks following surgery is warranted to identify and treat toxic keratoconjunctivitis and corneal ulceration resulting from collagenase activation secondary to postoperative corticosteroid therapy. If prescribed, topical nonsteroidal anti-inflammatory drugs (NSAIDs) should be used with caution because of the increased risk of corneal melting. In extreme cases, persistent epithelial defects with stromal loss may require a bandage (therapeutic) contact lens, tarsorrhaphy, or an amniotic membrane transplant.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.