Dry Eyes After Cataract Surgery

Introduction:

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

After What Surgeries Do Dry Eyes Occur?

Dry eyes can be seen in patients undergoing cataract surgery, 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.

Some patients are unsatisfied with the surgery even after getting a perfect vision of 6/6. Even though the surgery was uneventful, these patients usually complain of watering, the feeling of grittiness, something irritating in the eyes, foreign body sensation, frequent blinking, etc. Ocular discomfort can range from simply not satisfactory (unable to explain the reason) to a blurring of vision, improving blinking.

Everyone knows what tears are, but have people ever wondered where these tears come from? What is their composition? What are their functions? Are people curious to get the answers to these questions? Continue reading further.

How Are Tears Produced?

The formation of tears, right from secretion to drainage, is complex and requires 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.

What Are the Constituents of Tears?

Tears comprise nearly 98% water, but other constituents are also important, like sodium, potassium, chloride, bicarbonates, glucose, proteins, amino acids, etc., to keep the tears' pH slightly alkaline. The tear film is not just a single layer but comprises three layers, about which I will not discuss. Still, for the basic understanding, every layer is important, has functions and compositions, and is secreted by different glands.

Do All Patients Get Dry Eye Syndrome After Cataract Surgery?

Dry eye syndrome after cataract surgery is common among people who undergo surgery. It is possible that about 42 percent of people had dry eyes after undergoing cataract surgery. Some people also develop side effects after surgery. Some patients may also have mild dry eye syndrome. Dry eye syndrome also occurs after various surgeries, like photorefractive keratectomy (a laser treatment used to correct the refractive index of the eyes).

Will Dry Eye Syndrome Make My Eyes Take Longer to Heal After Cataract Surgery?

If people had dry eye syndrome after surgery, one set of people could be curable in a few weeks, and others could have dry eye syndrome for about one to two months. Although this surgery is safe, there may be a chance of getting dry eye syndrome due to some disorders people may already have. If people are treated with eye drops, it may take one or two months to recover from dry eye syndrome.

What Causes Dry Eyes After Eye Surgeries?

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, which is needed for the adherence of the tears to the ocular surface and retention. Any discontinuity or irregularity will interfere with properly spreading tears to the ocular surface. Some of these factors are reversible and may take several months to years to recover. 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 that when we undergo surgery on the cornea, lens, retina, or eyelids, the basic structure is disturbed, and tear secretion is affected to a great level. However, the risk versus benefit ratio is quite low. It is determined to a great level by the quality of surgery, type of surgery undergone, and patient compliance with using medicines.

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

What Signs Do Dry Eyes Cause?

Dry eyes can present as,

• Redness of the eyes.

• Irritation.

• Blurry vision.

• Burning sensation of the eyes.

• Sensitivity to bright light.

• A sensation of the presence of a foreign body in the eyes.

• Watery eyes.

How Long Will Dry Eyes Last After Eye Surgery?

The duration 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, for extended periods. As it is a reversible process, the recovery depends on the patient's general health condition, including the immune status, which will decide how long it will take to recover. Complete recovery can be expected in case of no pre-existing dryness and no risk factors aggravating the disease like poor hygiene, poor control of diabetes, dyslipidemia, etc.

How Are Dry Eyes After an Eye Surgery Treated?

Treatment options for surgery-induced eye dryness include:

• Ocular hygiene.

• Good wound care.

• Control of any systemic metabolic disease.

• Compliance with the medicines regarding the number of doses and duration as prescribed by the surgeon.

• Lubricants, also known as artificial eye drops with or without preservatives.

• To improve dry eye symptoms, people can reduce screen time and take occasional breaks to relieve the strain on the eyes. Wear sunglasses covering the eyes for protection from bright light, pollution, and foreign particles. Individuals can also use humidifiers in their homes.

Can Surgery-Induced Eye Dryness Be Prevented?

There are ways that ophthalmologists treat people 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. 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 benefits to a large extent.

Conclusion

Dry eye syndrome is developed due to the interaction of lubricants in the eyes during surgery. It is normal to have dry eyes after cataract surgery; proper management for dry eye symptoms is taken. It is possible to cure it in a few weeks after surgery. Using artificial tears and following the doctor's recommendations can help reduce dry eye symptoms. Washing the eyes repeatedly with fresh water helps reduce dry eye syndrome.