A prospective study of dry eye after cataract surgery

Abstract

Background: Dry Eye Disease (DED) is a common yet often underrecognized complication following cataract surgery, impacting patient comfort and visual outcomes. With advancing age, altered ocular surface physiology, and variable surgical and postoperative practices, the risk of DED becomes more pronounced. Objectives: To evaluate the incidence, severity, and risk factors associated with Dry Eye Disease in patients undergoing cataract surgery, and to compare its occurrence across different age groups, genders, surgical techniques, comorbidities (particularly diabetes), and types of postoperative medications. Methods: A prospective observational study was conducted on 340 patients undergoing cataract surgery. Patients were assessed preoperatively and followed up at 1 week and 4 weeks postoperatively. Schirmer’s test, Tear Break-Up Time (TBUT), and corneal staining scores were recorded. The type of surgery (phacoemulsification vs. SICS), postoperative eye drops (preservative- containing vs. preservative-free steroids), and presence of diabetes were also analyzed in relation to DED incidence. Results: The highest incidence of DED was observed at 1 week postoperatively (57.3%), which declined to 41.8% at 4 weeks. A statistically significant decrease in mean Schirmer’s values (14.2 ± 3.5 mm pre-op to 9.8 ± 2.9 mm at 1 week) and TBUT (11.5 ± 2.8 sec to 7.3 ± 2.1 sec) was noted (p<0.001). Females (54.4%) and patients aged 56–65 years (41.2%) had a higher prevalence. SICS had a higher incidence of DED (60.5% at 1 week) compared to phacoemulsification (54.8%). Use of preservative-containing steroids was associated with higher DED incidence (67.6% vs. 32.4%). Diabetic patients had significantly higher risk (66.7%) compared to non- diabetics (35.7%). Conclusion: Cataract surgery leads to a transient but clinically significant incidence of Dry Eye Disease, especially in older individuals, females, diabetic patients, and those undergoing SICS or receiving preservative-containing eye drops. Preoperative screening and postoperative management strategies targeting these risk groups are essential to reduce DED burden and improve postoperative comfort and outcomes.