These treatment options can also be expanded. I then continue it postoperatively until the ocular surface is superb. 'I like to start this therapy two weeks before cataract surgery, but optimally four weeks before surgery. 'I taper off loteprednol after two weeks and continue Restasis indefinitely until after the cataract surgery,' he says. For patients with dry eye due to aqueous deficiency, he uses artificial tears in combination with loteprednol four times a day with Restasis over a two-week period.

For patients with meibomian gland dysfunction and blepharitis, he uses hot compresses, lid hygiene and oral nutritional supplements, such as flaxseed oil and fish oils. Donnenfeld aims therapy at treating the underlying condition.

For mild dry eye, we may just go with lubricating drops.'ĭr. For moderate to severe dry eye, the recommended treatment is nonpreserved artificial tears, topical cyclosporine A, and, occasionally, topical steroid drops to get the corneal epithelium in the best possible shape before we proceed with cataract surgery. 'We should gear therapy toward the level of dry eye. 'If there is any doubt about the diagnosis, Schirmer testing may be helpful,' he says. He notes that dyes such as fluorescein, lissamine green or rose bengal can be used to identify more subtle cases of ocular irritation. Buznego routinely assesses cataract surgery patients for dry eye during the history and slit-lamp exam. It is important to get significant dry eye under control before you proceed with surgery because it can potentially affect your IOL calculations.'ĭr. 'Typically, I see a nice improvement on the ocular surface after a week or two of treatment. 'It doesn't take long to see an improvement,' he says. He typically uses Restasis (cyclosporine ophthalmic emulsion 0.05%) and punctal plugs during the preoperative period in patients with pre-existing dry eye. William Trattler, MD, in practice at the same center, agrees. If they have moderate to severe dry eye, the dry eye needs to be addressed preoperatively,' says Carlos Buznego, MD, who is in private practice at the Center for Excellence in Eye Care, in Miami. It is important to preoperatively assess patients for concurrent problems, especially dry eye. Many patients complain that their eyes are still stinging and burning. 'As cataract surgeons, we may successfully remove the cataract and then be surprised when patients are not satisfied with the result. Often, when patients present with cataracts, surgeons are so focused on planning for the surgical procedure that they overlook dry eye symptoms. In fact, approximately 20 percent of patients undergoing cataract surgery probably have underlying dry eye.' Dry eye is common in this patient population. 'In addition, elderly patients are more sensitive to the medications that are given during cataract surgery, particularly nonsteroidal anti-inflammatory drugs, which can also damage the ocular surface. He is also co-chairman of Cornea at Nassau University Medical Center.

'Because cataract surgery is incisional and because most cataract patients are older, there is almost always going to be a general worsening of dry eye after cataract surgery,' says Eric Donnenfeld, MD, who is in private practice at Ophthalmic Consultants of Long Island in Rockville Center, NY. This postoperative dry eye can negatively affect visual outcomes and visual recovery time. Additionally, cataract surgery has been found to exacerbate pre-existing dry eye and to induce dry eye in patients with healthy corneas. Dry-eye disease is estimated to affect more than 7 million Americans, and the prevalence of dry eye increases with age.

Blurryness after warm eye compress