Does Cataract Surgery Cause Dry Eyes?

Dry Eyes and Cataract Surgery

Although surgeries have advanced tremendously and shown great success, some patients may experience dry eyes as a side effect. This relatively common side effect can affect the visual outcome and cause discomfort after surgery.

With most ocular surgeries, the front surface of the eye, called the cornea, typically gets an incision or cut. This process can sever the corneal nerves and alter corneal sensation following the ocular surgery. Due to this, many surgeries such as LASIK, PRK or cataract surgery can cause dry eyes to worsen as it can affect normal tear production and disrupt the tear film.

Symptoms of Dry Eye After Surgery

Some common symptoms can include burning, redness, blurry vision, grittiness or itching. You may also experience light sensitivity and excess tearing as your eyes compensate for the dry eye symptoms.

Some risk factors for developing dry eye after surgery include older age, previous history of dry eye, certain medications and environmental factors like ceiling fan use or excessive screen use. There are also important drops that need to be used after surgery, including topical antibiotics and steroids. These eye drops can contribute to dryness due to the presence of preservatives.

Why is it Important to Address Dry Eye Before Surgery

Ocular surgeries, such as cataract surgery and LASIK, should not be rushed into! If you present with severe dry eye signs, it is highly recommended that you are able to get your dry eye symptoms under control before proceeding with surgery.

For refractive surgery, measurements need to be taken to determine the visual correction. If the tear film is unstable, it can lead to poor measurements and less than ideal visual outcomes after surgery. Due to this, it is highly recommended to treat pre-existing dry eye disease before ocular surgery.

For cataract surgery in particular, a surgeon measures your eye to determine the power of the IOP implant. If your ocular surface is compromised or unstable, it can lead to measurement errors and poor reliability in the data. Due to this, you can be left with residual astigmatism, near sightedness or far sightedness after surgery.

During the process of surgery, the corneal incisions sever the corneal nerves and can affect the feedback mechanism for normal tear production. Also, drops that are used pre and post operatively, can affect the ocular surface homeostasis and irritate the eyes due to the presence of preservatives. Exposure to irrigation and drying during the surgery can also aggravate the ocular surface.

The risk of infection after surgery may also increase if certain conditions are left untreated, such as blepharitis. Blepharitis is overgrowth of bacterial buildup on the eyelashes and lid margins. Due to the close vicinity of the bacteria to the ocular surface, it can get into the eye during surgery and can lead to a serious infection.

Even if dry eye symptoms are mild before surgery, symptoms can worsen and become more prominent and negatively affect your vision after surgery. There are many ways of reducing the risks of this common side effect based on what specific signs are contributing to your dry eye disease.

Managing Dry Eye Before and After Surgery

It is important to initiate therapy if you experience dry eye symptoms before or after
surgery. Treatments will start off with over-the-counter options, such as preservative-free
artificial tears, ointments, warm compresses or lid hygiene products.

If the eyes are not responsive to over-the-counter treatment options, prescription
medications may be necessary. This can include immunomodulators, such as Vevye, Cequa or
Xiidra. These prescription drops can help manage inflammation and increase tear production.

Now we have a variety of prescription-based options for dry eye management. Tyrvaya
is an intranasal neurostimulator that helps stimulate basal tear production. Another novel
medication called Miebo is the first of its kind to manage evaporative dry eye disease. This is a
great option that can help stabilize your tear film and reduce tear evaporation.

Based on your ocular presentation, your doctor may decide to initiate in-office treatments
as well. These can include punctal plugs to help retain more tears and keep the ocular surface
lubricated. They may also consider treating with an amniotic membrane, such as Prokera, which
is derived from placenta tissue taken from healthy cesarean births. This powerful tissue can
heal corneal damage from dry eye disease before and after surgery and promote corneal nerve
regeneration.

Some other intensive in-office treatments include thermal gland expression, IPL and in-
office eyelid and eyelash cleaning. Improving meibomian gland function with these effective
treatments improves your tear stability and provides a healthy ocular surface to operate on.
Eyelid and eyelash cleaning also aids in controlling the amount of bacteria around your eyes to
reduce the risk of infections after surgery.

How Long Does Dry Eye Last After Surgery?

Dry eye symptoms are usually worse during the first week and should improve over the
first month. If symptoms persist or your vision changes, it is important to be evaluated by an eye
doctor to determine if further management is needed.

If you are planning on undergoing surgery or experiencing dry eyes after having surgery
done, reach out for options on how to manage your condition and improve your quality of life!

-Norin Ali, OD