This article deals with surgery-induced dryness of the eyes. Maybe if you are not informed about this possibility before undergoing surgery, this article will help you be more informed about the outcome.
Eye surgeries, including cataract surgery and refractive surgeries, have become 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.
Dry eyes can be seen in patients undergoing surgery for cataracts, refractive surgeries like LASIK (to get rid of spectacles), ocular surface disorders, squint-correction surgeries, and many more. The incidence is comparatively lower in extraocular disorders.
There are 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 knows what tears are but have you ever wondered where these tears come from? What is their composition? What are their functions? Are you curious to get the answers to these questions? Continue reading further.
The formation of tears, right from its secretion to drainage, is a very complex phenomenon and requires 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 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 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 surgery, some of the nerves naturally get cut while giving an incision which cannot be prevented. So, the sensation of the cornea is reduced after surgery, which is also responsible for the decreased tear secretion.
Another factor is the loss of goblet cells responsible for the secretion of the innermost mucus layer, that is needed for the adherence of the tears to the ocular surface and retention. 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 several 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 healing will occur.
Long, microscopic light exposure during surgery can also result in dry eyes.
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 determined 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 your mind to avoid 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 dry eyes can present as,
Burning sensation of the eyes.
Sensitivity to bright light.
A sensation of the presence of a foreign body in the eyes.
The lasting time of dry eyes varies depending on the severity and presence of a pre-existing disease. In some cases, treatment may not be required, may be required for the initial few months only, or in some cases for more extended 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 for surgery-induced eye dryness include:
Good wound care.
Control of any systemic metabolic disease.
Compliance with the medicines regarding the number of doses and duration as prescribed by your surgeon.
Lubricants, also known as artificial eye drops with or without preservatives.
To improve your dry eye symptoms, you can reduce your screen time and take occasional breaks to relieve the strain on your eyes. Wear sunglasses that completely cover your eyes for protection from bright light, pollution, and foreign particles. You can also use humidifiers in your house.
There are ways that your treating ophthalmologist can follow to minimize the severity of postoperative dry eyes.
In the case of laser eye surgery, creating small and thin flaps can decrease the number of nerves getting cut during surgery.
Exposure to the microscope light during the procedure must be minimized by using short exposure times and filters.
Also, since the incidence of postoperative dry eyes is reported in those who already have dry eyes diagnosed or undiagnosed, treating eye surgeons prefer to resolve existing dry eyes before the procedure. For this, they prescribe Cyclosporine ophthalmic emulsion 0.05% at least two to four weeks before the eye surgery.
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
Last reviewed at:
04 Feb 2022 - 4 min read
Query: Hello doctor, My 68-year-old mother has cataracts in her both eyes. She is advised to have a cataract surgery in her right eye. But her blood sugar level is 150 mg/dL at fasting and 190 mg/dL postprandial. Her HbA1c is 8.8%. We are confused whether cataract operation can be undertaken with this sug... Read Full »
Query: Dear doctor, The patient is a 76-year-old male. I am uploading eye check-up report. Kindly advise on the following: Is cataract shown in the report? Is cataract operation required immediately? Is retina covered in the checkup? Any other observations by you? Read Full »
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