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Dry Eyes After Cataract Surgery

by Dr. Shikha Gupta at 08.Feb.2018 on Eye Health


Abstract:

This article deals with the surgery-induced dryness of the eyes, and this is important because often it may so happen that you may not be informed about this possibility before undergoing surgery. So, this article will help you be more informed about the outcome.

Eye surgeries including cataract surgery and refractive surgeries have advanced with newer developments in the field. But regardless of the surgery that you undergo, the incidence of dryness increases post-surgery and the incidence is higher in the predisposed individuals.

This can be seen in patients undergoing surgery for cataract, refractive surgeries (to get rid of spectacles), ocular surface disorders, squint-correcting surgeries and many more. The incidence is comparatively lower in extraocular disorders.

We usually encounter patients who are not satisfied with the surgery even after getting a perfect vision of 6/6. Even though the surgery was uneventful, these patients usually complain of watering, feeling of grittiness, something irritating in the eyes, foreign body sensation, frequent blinking, etc. Basically, ocular discomfort can range from simply not satisfactory (unable to explain the reason) to a blurring of vision which improves on blinking.

Everyone has heard of tears but from where do these tears come from? What is their composition? What are its functions? So many questions must have come to your mind and you must be curious to get the answers to these questions.

The formation of tears, right from its secretion to drainage, is a very complex phenomenon and require very coordinated and integrated efforts by the lacrimal gland, ocular surface (cornea, sclera, and conjunctiva), eyelids, and patent punctum. These are the physical factors governing tear secretion but chemical factors (composition) and neurological factors (normal corneal sensations) also play a major role.

Tears comprise of nearly 98 % water but other constituents are also important like sodium, potassium, chloride, bicarbonates, glucose, proteins, amino acids, etc., to maintain the pH of tears as slightly alkaline. The tear film is not just a single layer but comprises of three layers about which I will not go into the details, but for the basic understanding, I would like to add that every layer is important and has its own functions, compositions, and are secreted by different glands.

During a surgery, some of the nerves naturally get cut while giving any incision which cannot be prevented. So, the sensation of the cornea is reduced after surgery and this is also responsible for the decreased response of tear secretion.

Another factor is the loss of goblet cells responsible for the secretion by the innermost mucous layer which is responsible for the adherence/retention of the tears to the ocular surface. Any discontinuity or irregularity will interfere with the proper spreading of tears to the ocular surface. Some of these factors are reversible and may take from months to years for a complete recovery. And sometimes, complete recovery is not possible. The response varies from one patient to another and unfortunately, we cannot predict exactly how much recovery will occur.

So, the basic idea is, when we undergo any surgery on the cornea, lens, retina, or eyelids, the basic structure is disturbed and the tear secretion is affected to a great level. But the risk versus benefit ratio is quite low and is affected to a great level by the quality of surgery, type of surgery you undergo, and patient's compliance for using medicines.

The basic idea is not to instill in your mind not to go for surgery but just to pre-inform you in case it was missed out by your surgeon so that you are aware this can happen and not get disappointed if it does.

The length of treatment varies depending on the severity and presence of a preexisting disease. In some cases, it may not be required, may be required for initial few months only, or in some cases for longer periods as well. As it is a reversible process, the recovery depends on the general health condition of the patient including the immune status which is actually going to decide how long it will take to recover. Complete recovery can be expected in case of no pre-existing dryness, no risk factors aggravating the disease like poor hygiene, poor control of diabetes, dyslipidemia, etc.

Treatment Options Include:

  1. Ocular hygiene.
  2. Good wound care.
  3. Control of any systemic metabolic disease.
  4. Compliance with the medicines regarding the number of doses and duration as prescribed by your surgeon.
  5. Lubricants with or without preservatives.

With this little effort of mine, I hope the general population gets benefitted to a large extent.

For more information consult a cataract specialist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist/cataract

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