Pearls for the Preoperative Evaluation and Postoperative Management of the Ocular Surface in Cataract Surgery Patients

Neil J. Friedman, M.D.

About Author

Goal: Restore ocular surface health and quality of tear film to maximize surgical refractive outcome.

PREOP EVALUATION

History:

• Ocular surface disease (i.e., dry eye, blepharitis)
• Use of lubricating drops
• Symptoms: burning, stinging, foreign body sensation, dryness, contact lens intolerance, fluctuating vision. May be exacerbated by reading, computer work, low humidity and circulating air

Slit lamp findings:

• Corneal staining with fluorescein (interpalpebral or inferiorly)
• Reduced tear meniscus height
• Decreased tear breakup time (<10 seconds)
• Meibomian gland inflammation/obstruction

Additional testing:

• Lissamine green/Rose bengal stain (interpalpebral conjuntiva and cornea)
• Schirmer’s test (<10 mm after 5 minutes)
• Corneal topography (irregularity and blank spots)

Treatment:

• Lubrication
• Restasis
• Consider short course of topical steroids
• Hot compresses/lid scrubs for blepharitis
• Consider punctal plugs

POSTOP MANAGEMENT

Evaluation: as above

Treatment (for any signs or symptoms):

• Increase lubrication
• Add Restasis and/or punctal plugs
• Minimize BAK exposure

Note: Patients commonly use topical steroids/NSAIDS for 4-6 weeks after cataract surgery, and this may mask ocular surface disease until the drops are stopped.