June 2019


Dry eye developments

by Clara Chan, MD EyeWorld Cornea Editor

Practical diagnostic and management strategies of dry eye are important because all of us in ophthalmology see patients with either symptoms or signs of dry eye. More importantly, we all cause or exacerbate dry eye in our patients in our pursuit of helping them with other issues: We treat glaucoma with long-term eye drops, we perform intravitreal injections, we may render a cornea neurotrophic after a penetrating keratoplasty or more commonly, by performing cataract or refractive surgery. Some of us may be tempted to give a few bottles of artificial tear samples and hope they don’t return. But given the chronic nature of dry eye disease, it is not a realistic strategy to hope some artificial tear samples will be satisfactory. Furthermore, the incidence of dry eye in patients undergoing cataract surgery in a real-world setting is higher than anticipated.
Before continuing the conversation about dry eye developments in this month’s In Focus series, it’s important to keep the peer-reviewed literature in mind. Trattler et al. found in a prospective study that of 136 patients scheduled to undergo cataract surgery, 77% had positive corneal staining, 63% had an abnormal tear breakup time of less than or equal to 5 seconds, and 18% had Schirmer’s score with anesthesia of less than or equal to 5 mm.1 Gupta et al. looked at 120 consecutive patients presenting for cataract surgery evaluation and found that 80% had at least one abnormal tear test (osmolarity or MMP-9).2 A couple of recent publications have reshaped how dry eye disease is defined and understood. The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS II) report was published in 2017.3 In last month’s Journal of Cataract & Refractive Surgery, the ASCRS Cornea Clinical Committee presented an algorithm for the preoperative diagnosis and treatment of ocular surface disorders.4 There will be more discussion about those recommendations in an upcoming EyeWorld. Stay tuned.


1. Trattler WB, et al. The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423–1430.
2. Gupta PK, et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090–1096.
3. TFOS DEWS II. www.tfosdewsreport.org/report-tfos_dews_ii_report/36_36/en/
4. Starr CE, et al. An algorithm for the preoperative
diagnosis and treatment of ocular surface disorders.
J Cataract Refract Surg. 2019;45:669–684.

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