April 12, 2019 Conference


The Ocular Surface and Cataract Surgery

Dr. Helen K. Wu, Tufts Medical Center (Presenter)

Ocular surface disease is common in patients seeking cataract surgery.  The presence of preexisting dry eye or other ocular surface disease may affect preoperative keratometric and topographic measurements, leading to potential errors in astigmatism or lens implant calculations.  A compromised ocular surface may also adversely affect quality of vision through multifocal lenses, leading to significant patient dissatisfaction.  In addition, preexisting ocular surface disease may be exacerbated by cataract surgery, leading to such potential risks as infection and corneal melting, particularly in patients with underlying autoimmune or neurotrophic disorders.  It is thus imperative to recognize and treat ocular surface disease preoperatively, so as to assure optimal outcomes.

The diagnosis of ocular surface disease may be made using a variety of tests, including patient symptom questionnaires, tear break up time, Schirmer testing, conjunctival staining, and tear film osmolarity.  Imaging studies such as meibography and confocal microscopy may be helpful in delineating disorders of the Meibomian glands or corneal nerves.  Clinical signs should guide the choice of treatment options.  A stepwise approach utilizing artificial tears, anti-inflammatory agents, punctal occlusion, treatment of blepharitis and meibomian dysfunction, and autologous serum tears and other compounded medications may be utilized.  Systemic immunosuppressant agents may be necessary in patients with severe preexisting ocular surface disease and underlying systemic autoimmune and inflammatory disorders.