The preoperative evaluation of a patient with cataract includes the body habitus and any abnormalities of the external eye and ocular adnexa. Conditions that may affect the surgical approach include extensive neck fat, kyphosis, ankylosing spondylitis, generalized obesity, or head tremor. The presence of enophthalmos or prominent brow may affect not only the surgical approach but also the chosen route of anesthesia.
Entropion, ectropion, or eyelid closure abnormalities, as well as abnormalities in the tear film, may have an impact on the ocular surface and thus adversely affect postoperative recovery if not addressed preoperatively. Severe blepharitis or acne rosacea may pose an increased risk of endophthalmitis and should likewise be treated before cataract surgery. Active nasolacrimal disease should also be treated, particularly if there is a history of inflammation, infection, or obstruction.
Motility and Ocular Dominance
Ocular motility can be determined by evaluating ocular alignment and testing the range of movement of the extraocular muscles. Cover testing helps determine any muscle deviation. Abnormal motility may suggest preexisting strabismus with amblyopia as a cause of vision loss. Patients must be made aware that they may experience diplopia after cataract surgery if they have a significant tropia resulting in disruption of fusion. Removal of a dense cataract may improve vision but make the patient aware of ocular misalignment.
The examination can also include an assessment of ocular dominance. Ocular dominance can be important if considering monovision; however, the importance of this in planning monovision is debatable.
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.