Tears serve important functions in eye health. They lubricate our eyes, allow us to see clearly by helping focus light, and protect against dust, dirt, and infection. When tears are in short supply, our eyes lose those protections. This condition is called dry eye disease (DED). DED can have natural causes, occur after an injury, or result from eye surgery such as cataract removal. Fortunately, there are treatment options for this disorder.*

About DED

Over seven (7) million Americans live with DED. It’s especially common after cataract surgery, and cataract surgery can also worsen existing symptoms. 

DED has many causes: insufficient tear production, excessive tear evaporation, or a combination of both. This can happen due to Sjogren’s Syndrome, glandular dysfunction, or an obstruction that leads to weakened glands and less oil for the eye surface.

A variety of factors can exacerbate DED, including:

• Aging
• Environment (chemical fumes, cigarette smoke, etc.)
• Medications that affect the whole body (antihistamines, non-steroidal anti-inflammatory drugs/NSAIDS, steroids, etc.)
• The use of multiple drugs, including eye drops, for one or more conditions 

Cataract surgery and DED

Cataract surgery can increase your chances of developing DED in several ways:

• Corneal nerve damage during the procedure, 
• Inflammation of the eye surface, and
• Frequent use of eye drops containing preservatives after the surgery. 

Although uncommon, extended microscope light exposure and frequent irrigation of the eye surface can also cause DED after surgery.

Assessing and treating DED before surgery

Before cataract surgery, the eye surface is evaluated for any abnormalities using various dyes.

• Fluorescein is commonly used in conjunction with cobalt light to find foreign bodies or corneal damage, and evaluate the eye for tear function (break up time).
• Lissamine green, another stain, can identify DED in patients who show symptoms but haven’t responded to fluorescein.

Sciandra recommends beginning treatment for DED before cataract surgery, to optimize the eye surface for accurate testing. Commonly recommended remedies include:

• Over-the counter artificial tears, for mild DED, and
• Drugs like cyclosporine (Restasis®, Cequa®), for moderate-to-severe DED.

(More than one office visit may be needed to assess medication suitability.) 

DED can also be relieved using home remedies, Sciandra says, though they have not been scientifically validated. These can include:

• A hot compress on the eye for five (5)-10 minutes per session
• Warming masks, such as Bruder’s microwavable eye mask and Dr. Prepare’s heat-controllable USB mask
• Proper eyelid hygiene, like removing all eye makeup with cleaning pads and face wash
• Omega-3 fish oil supplements, to increase natural oils on the eye surface and improve lubrication

Assessing and treating DED after surgery

Your doctor will likely conduct testing after surgery to confirm successful cataract treatment and gauge DED. The fluorescein stain test can be used to look for any changes to the cornea or eye surface after surgery.

There are two common DED treatment categories after surgery.

• Artificial tears applied topically to the eye are the most common treatment, temporarily restoring the tear film over the eye while providing quick symptom relief. 
• Steroids applied topically are another common eye drop treatment after cataract surgery. For DED flare-ups, however, low-dose topical steroids may be used for an extended period under your doctor’s supervision, as they can cause glaucoma.
  

Surgery beneficial, but DED awareness important

Cataract surgery is safe, effective, and can improve your quality of life. That said, DED can arise after surgery, causing discomfort and visual disturbances. It’s important that you are knowledgeable about your pre-existing conditions. People may not realize the severity of their DED if they have few or no symptoms, but surgery can trigger disturbances in the eye’s surface.

Sciandra advises treating DED as a chronic condition. “While there are no curative therapies,” she says, “there are many options that will help significantly improve symptoms over time.”

*Sciandra, C. (2021, July 30). Everything To Know About Dry Eye After Cataract Surgery. Eyes on Eyecare. https://eyesoneyecare.com/resources/everything-to-know-about-dry-eye-after-cataract-surgery