Dry eye disease and cataract surgery: identification of risk factors for corneal damage and optimisation of treatment
Various factors in the perioperative cataract surgery period can synergistically initiate a vicious inflammatory cycle of dry eye disease (DED) and tissue damage, with dire consequences. A careful anamnesis and preoperative assessment of the ocular surface can reveal some of the risk factors and facilitate an appropriate perioperative approach. Attention should be paid to DED and associated conditions, such as Meibomian gland dysfunction, as these conditions are very common. In the postoperative period, it is wise to avoid preserved topical medication, as well as to use topical medication that may be toxic to the ocular surface, such as non-steroidal anti-inflammatory drugs (NSAIDs), with care in specific cases. The treatment of DED and its complications consists primarily of the careful use of lubricating, antibiotic and anti-inflammatory agents. In serious DED cases, autologous serum promotes tissue regeneration by promoting epithelialisation and stromal recovery, and can be a useful adjunct to the first-line treatment. In extreme and rare cases, DED can, in combination with the use of topical NSAIDs and other risk factors, lead to sight-threatening complications, such as corneal melting. A surgical treatment consisting of conjunctival flap transplantation, amniotic membrane transplantation, gluing of the cornea or tectonic keratoplasty may be necessary when perforation is imminent.
Ocular surface and proteomic safety biomarkers in topical medication