Dry Eye and Ocular Surface Disease Bonus Issue
October 2025
by Sumit “Sam” Garg, MD
Chief Medical Editor
The proper management of ocular surface disease (OSD) is a cornerstone for successful anterior segment surgery and overall ocular health. For anterior segment eye surgeons, understanding and addressing these conditions is no longer optional—it is essential for optimal surgical outcomes and patient satisfaction. This bonus issue of EyeWorld focuses on updates in OSD and the impact this near ubiquitous disease has on our patients.
The tear film’s contribution to the optical system is fundamental, as an abnormal tear film can cause foreign body sensation, fluctuating vision, contact lens intolerance, poor quality of vision, and critically, inaccurate IOL power calculations. Not being proactive with OSD management can lead to several unanticipated issues in the perioperative patient. This includes patient dissatisfaction and often requires additional postop visits to address these issues properly.
The ASCRS Preoperative OSD Algorithm has been developed specifically to address this challenge, providing surgeons with a systematic approach to identify and treat ocular surface disorders before surgery. This algorithm is designed to be “easy to follow and easy to integrate into the presurgical evaluation,” according to Christopher Starr, MD, and can be adapted to whatever diagnostic tools are available in the clinic.
Effective management begins with thorough preoperative evaluation. Surgeons should ideally examine cataract patients before any drops are instilled, following a systematic approach that includes assessing the tear film, examining the lids and lashes for conditions like Demodex mites, evaluating meibomian gland health and meibum quality, and checking for signs of underlying inflammation. This comprehensive assessment takes approximately 30 seconds but can significantly impact surgical planning and outcomes.
Collaboration is crucial. Many anterior segment surgeons benefit from partnering with dry eye specialists and referring optometrists to establish “a synergistic, co-management relationship.” This approach ensures patients receive optimal care from providers with specific expertise in ocular surface disease.
Patient education and “buy in” is fundamental to successful OSD management. Some patients may be initially surprised that ocular surface treatments can delay their cataract surgery, making education about goals and expectations crucial from the start. When patients understand how and why these issues are treated, they become much more willing to undergo preoperative treatments for improved outcomes and quality of life. They are also more likely to remain compliant with treatments when they understand the “why.”
The management of OSD represents a critical component of modern anterior segment surgery and overall ocular health. By implementing systematic screening protocols, utilizing appropriate treatment modalities, fostering collaborative care relationships, and prioritizing patient education, surgeons can significantly improve surgical outcomes, enhance patient satisfaction, and contribute to long-term ocular health. The integration of OSD management into routine practice is not just beneficial, it is essential for delivering optimal patient care in today’s surgical environment. I hope you enjoy this bonus issue of EyeWorld. If you have any suggestions for topics, improvements, etc., feel free to reach out to me at gargs@uci.edu.
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Marjan Farid, MD, EyeWorld Cornea Editorial Board member, shared her thoughts on dry eye and ocular surface disease:
“With our ever-expanding knowledge of dry eye disease and the natural mechanisms responsible for our healthy tear production, we are excited to see novel therapies that address the ocular surface and tear film in a more targeted approach. Our ability to treat patients is getting better. We cannot ignore the ocular surface as the first optical layer of the eye, especially in our preoperative cataract and refractive patients whose vision we are trying to enhance.”
