Dry Eyes Before Cataract Surgery

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Dry eye is a condition that occurs when you do not make enough tears or the tears that you do make are of poor quality and unable to keep your eyes lubricated enough. Dry eye before cataract surgery is common. It's important to treat dry eye before surgery because the surgery itself can make dry eye worse, affecting your vision after surgery.

This article will address the number of people with dry eye before cataract surgery, how dry eye affects you both before and after cataract surgery, and treatments commonly used for dry eye.

Older woman having eye drops instilled by medical professional

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Dry Eye Before Cataract Surgery

More than 16 million Americans have dry eye. Dry eye is much more common in advanced age. In a 2017 study, dry eye was identified in just 2.7% of people ages 18–34 compared to 18.6% of those ages 75 and older.

Cataract, or a clouding of the lens, also is more common with age. So, it is probably not surprising just how common it is for cataract patients to also have dry eye.

In another 2017 study, researchers found signs of dry eye in more than half of the patients they studied when using specific dry eye tests. At the time of the study, only 22% of the patients had an official dry eye diagnosis. This means that dry eye in the cataract-age population is often underreported.

Some symptoms of dry eye include:

  • Blurred vision
  • Burning and stinging of the eyes
  • Difficulty wearing contact lenses
  • Having excess tears in the eye

Causes of dry eye include:

  • Certain diseases, such as rheumatoid arthritis (RA, an autoimmune disease causing joint pain and damage)
  • Hormonal changes
  • Some types of medications, such as allergy and cold medicines that can make the eyes feel dry
  • Using electronic screens for a long time

Why Factor Dry Eye Into Cataract Surgery?

Ophthalmologists (medical doctors specializing in conditions of the eyes) who perform cataract surgery are giving dry eye more attention nowadays. There are a few reasons for this, including:

  • Cataract surgery can lead to an increase in dry eye symptoms. These symptoms may be uncomfortable.
  • Dry eye can affect results from cataract surgery. You may not see as well as you could if you did not have dry eye.
  • Dry eye can affect calculations for an intraocular lens (IOL). This is the artificial lens placed in your eye once the eye doctor removes your original lens. This could lead the surgeon to use an IOL that is less than ideal for your eyes.

Dry Eyes After Cataract Surgery

Researchers do not agree on how common dry eye is after cataract surgery. Studies have found as few as 9% and as many as 34% of patients have experienced dry eye after cataract surgery. Some causes of this include:

  • Changes to the eye created during surgery: Any type of eye surgery has the potential to cause dry eye or make it worse.
  • Misdiagnosis: Dry eye that was not diagnosed or not properly treated before surgery can persist.
  • Having very high expectations for the surgery: Some patients receive a premium intraocular lens (IOL) during cataract surgery. These are IOLs that cost more money but are further customized to your vision needs. Patients receiving a premium IOL sometimes have high vision expectations and are surprised by any minor vision problem.
  • Eye irregularities: An irregularity on the ocular surface from where the surgical incision was made could cause dry eye.
  • The surgical technique used: A newer approach called femtosecond laser-assisted cataract surgery (also called FLACS or laser cataract surgery) may be more likely to cause dry eye disease than traditional phacoemulsification, which is another common cataract surgery approach.
  • Medications: The use of medications and preservatives in eye drops could make dry eye worse.

Surgery Can Also Improve Dry Eye

It's possible for dry eye symptoms to improve in the months after your cataract surgery, Still, if you have dry eye symptoms after cataract surgery, make sure to let your eye doctor know.

Assessing Dry Eye

Before cataract surgery, your eye doctor will take a medical history and may conduct several tests to assess whether you have dry eye or how severe your dry eye is. These dry eye tests include:

  • A slit lamp exam: A slit lamp is a special microscope used to get a closer look at the eyes.
  • Schirmer testing: This involves placing a thin paper strip under the eyes and can help determine if the eye produces enough tears to keep itself moist.
  • Tear breakup time: This is to measure how long the layers of tears remain on your eyes after you blink.
  • Tear film staining: Applying a stain to the surface of the eye can reveal areas of damage or inconsistency.
  • Tear osmolarity: This can provide a measure of the amount of salt present in tears.
  • Topography: A computer-assisted tool to create a three-dimensional image of your cornea. This helps to check for corneal diseases.

Treatment for Dry Eyes Before Cataract Surgery

To help improve your dry eye before cataract surgery, your eye doctor may recommend several treatments. Your doctor may want you to use a combination of treatments to help your dry eye. Treatments used for dry eye before cataract surgery include:

  • Environmental changes to provide more moisture, such as using a humidifier and warm compresses
  • Using over-the-counter artificial tears, which come in many varieties, including preservative free
  • Using omega-3 fatty acid supplements, such as fish oil
  • Prescription medications that can improve the signs and symptoms of dry eye, including Restasis (cyclosporine) and Xiidra (lifitegrast)
  • Topical steroids to help treat inflammation
  • Punctal plugs, which will close your tear ducts and help preserve your tears

Treatments May Take Time to Work

It may take some trial and error to find which treatments help your dry eye condition the most. Your eye doctor may treat your dry eye for two to four weeks before assessing how your eyes have improved and deciding to proceed with your cataract surgery.

Summary

Dry eye is common before cataract surgery. More eye doctors are treating dry eye before surgery to ensure better vision results after surgery. There are many potential dry eye treatments, including medication, artificial tears, supplements, steroids, and punctal plugs. Some people still will experience dry eye after cataract surgery.

A Word From Verywell

Some people with dry eye have irritating symptoms that affect their vision. Other people do not even know they have it. In both cases, treating dry eye before cataract surgery can help improve your surgical results. Follow treatments recommended by your eye doctor, and ask for help if you have dry eye symptoms that continue after cataract surgery. There are more treatment options available nowadays.

Frequently Asked Questions

  • Can you have cataract surgery if you have dry eyes?

    Yes, you can still have cataract surgery if you have dry eyes. However, your eye doctor will likely try several ways to improve your dry eyes before proceeding with surgery. Your eye doctor may advise against a premium IOL if you have very bad dry eye.

  • Do dry eyes contribute to cataracts?

    No. The normal aging process is the main cause of cataracts. Other cataract causes include smoking, diabetes, and the use of certain medications, such as steroids.

  • Are eye drops necessary before cataract surgery?

    Not always. Many ophthalmologists, but not all, will prescribe eye drops before cataract surgery to prevent infection, decrease dry eye symptoms, or for other reasons.

  • How do you prepare your eyes before cataract surgery?

    The exact preparation for your eyes before cataract surgery will depend on what your eye doctor advises. You will have your eyes measured several different ways, and you may have to use certain eye drops before surgery. Follow any instructions you're given on what you can eat or drink on the day of your surgery.

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10 Sources
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