Dry eye disease (DED) affects all stages of cataract and refractive surgery, from planning to recovery. Accurate diagnosis and management are essential for optimal outcomes and patient satisfaction, yet DED is often underdiagnosed or undertreated preoperatively.

How does dry eye affect ocular surgery?

DED can impact multiple aspects of the surgical journey, contributing to inaccurate pre-operative measurements, suboptimal visual outcomes, delayed recovery, and reduced patient satisfaction.1

1.Pre-operative planning

Dry eye symptoms and tear film instability may compromise ocular surface quality before surgical planning begins.1

2.Diagnostic testing and workup

An unstable ocular surface can reduce the repeatability of keratometry and biometry measurements, affecting surgical planing.12,13

3.Surgical recovery

Ocular surgery can disrupt ocular surface homeostasis, contributing to new or worsening dry eye symptoms during recovery.10

4.Visual outcomes

Ocular surface disease may affect refractive accuracy and visual quality, increasing the risk of sub-optimal outcomes.8

5.Patient satisfaction

Persistent dry eye symptoms can contribute to dissatisfaction, even when visual acuity targets are achieved. 16

6.Quality of life

Ongoing ocular discomfort and visual disturbances can negatively affect daily activities and quality of live.9

Dry eye is highly prevalent among surgical candidates

A significant proportion of patients present with undiagnosed or subclinical Dry Eye.2-4

Prevalence in cataract surgery:

0-80%

of candidates for cataract surgery have some degree of DED pre- surgery.2,3,5

Prevalance in refractive (LASIK) eye surgery:

0-56.5%

of candidates for LASIK eye surgery have some degree of DED pre- surgery.6

Multiple patient, surgical, and post-operative factors contribute to the development or progression of dry eye.

  • Age>50 years & female sex
  • Systemic disease or medications
  • Pre-existing ocular surface disease
  • Surgical factors (procedure duration, femtosecond laser)
  • Post-operative/lifestyle factors (preserved drops, screen use)

Why peri-operative ocular surface control matters

A stable ocular surface helps generate more consistent measurements, supporting more accurate surgical planning and giving patients the best chance of achieving the results they expect.

Healthy ocular surface

Leads to

Healthy ocular surface

Leads to

A stable ocular surface can provide the foundation for accurate pre-operative assessement.8

Reliable biometry

Which supports

Reliable biometry

Which supports

More consistent pre-surgical measurements support a more dependable basis for clinical decision-making.12

Confident planning

Resulting in

Confident planning

Resulting in

Better-informed IOL and surgical decisions help clinicians plan with greater confidence before surgery.10

Better outcomes

Better outcomes

A stronger planning pathway supports improved visual outcomes and a better patient experience.15

Pathophysiology of peri-surgical dry eye

Peri-operative dry eye is multifactorial, driven by chemical, mechanical, and neural factors.

Some peri-operative agents can irritate the ocular surface. These may include:
Povidone-iodine, topical anaesthetic drops, preservatives in adjunctive therapies, and post-
operative medicines such as antibiotics, and NSAIDs.4,9,10

Surgical steps can physically affect the ocular surface. Corneal incisions, intraoperative drying, light exposure, speculum use and femtosecond laser suction may contribute to conjunctival damage, reduced mucin production, inflammation and reduced tear secretion.4

Surgery can affect corneal nerves, reducing corneal sensitivity and altering normal blink patterns. This may destabilise the tear film and contribute to post-operative dry eye symptoms.4,11

240222MERZ Lacrifill 0426 scaled | Lacrifill
s ahmad photo | Lacrifill

Prof. Sajjad Ahmad

shutterstock 1084716818 scaled | Lacrifill

Dry Eye impacts pre-operative measurements and surgical outcomes

Peri-operative dry eye is multifactorial, driven by chemical, mechanical, and neural factors.

An unstable tear film can affect the accuracy of pre-operative measurements used for surgical planning. Optimising the ocular surface before surgery helps improve measurement reliability, supports accurate IOL selection, and may reduce the risk of refractive surprises.12-14



Dry eye disease can affect the patient experience before and after surgery. Symptoms such as discomfort, fluctuating vision and ocular irritation may contribute to dissatisfaction, even when visual acuity outcomes are achieved. Optimising ocular surface health can help improve comfort, satisfaction and quality of life. 9,15,12



Yan Ning Johnson Neo – ISD DE | Lacrifill

Mr Johnson Neo