Very often, the post-operative period of eyes, whose surgery has been carried out perfectly, is studded, already on the first day, by patient discomfort phenomena who report a foreign body sensation, lachrymation, burning and photophobia.
Normally, the surgical act is united with a consequent inflammatory process, with the use of powerful disinfectants in the pre- and post-operative period and the use of eye drops with preservatives. All this can easily determine an alteration of the tear film with the appearance of a large number of symptoms that can let the patient feel post surgery troubles although the surgery had been perfectly carried out.
Also the perfonming of the simple incisions is responsible for the sensation of a foreign body that the patient sometimes reports with such insistence that he can underestimate the functional recovery obtained.
Post-operative dyslacrimia can have an acute course with short-term manifestations and subsequently recovers within a few weeks, or become chronic and have a longlasting course. Dry-Eye symptoms after cataract surgery can involve patients already affected by a pre-existing disease, with worsening symptoms as well as previously healthy patients, with no evidence of symptoms before surgery.
Refractive surgery is a procedure that has been practiced for over 30 years; this is safe and effective, with a rapid post-operative course and little discomfort in most cases. In fact, many patients are able to resume their daily activities after just 24 hours, especially if they have undergone surgery with the SMILE or LASIK technique. Some others, on the other hand, may have discomfort even lasting for a few weeks. In the first days after the operation, the following are quite frequent:
ache
burning
redness
itch
tearing
dryness
These symptoms generally last 24 hours when SMILE or LASIK is performed, while they can last over a week in the case of PRK. In some cases all the symptoms can appear in a very intense way especially in the first hours after the surgery. It may be necessary to stay in the darkness for a long time and rest.
In any case, approximately 30% of subjects may experience a decrease in tear production or an alteration of the tear film, conditions that lead the patient to experience the symptoms of Dry Eye.
Dry eyes can last for an average of 3 to 6 months, but the symptoms can be easily relieved with the use of tear substitutes.
Cataract surgery is one of the interventions characterized by a considerable increase in the quality of life as regards daily work activity and socio-relational aspects. Dry eye has an incidence between 11 and 33%, increasing with age with a significant impact on quality of life as it is usually for a chronic disease. Consequently, a high percentage of patients candidates for cataract surgery may have dry eye; this syndrome can be accentuated by the surgery or triggered by the surgery itself if while in a sub-clinical stage.
It is therefore important to identify patients at risk in order to establish adequate prevention and treatment. The cataract surgeon therefore not only focuses on the technical aspects of cutting-edge surgery, but also on the subjective and objective clinical signs that may indicate a dysfunction of the lacrimal system and in particular a dry eye in the overt or latent clinical stage. It is important that cataract surgery is performed on an ocular surface that is healthy or as normal as possible in order to prevent the anatomical and functional result from being reducted by dry eye syndrome. This occurs with a certain frequency after cataract surgery and it is the most common and potentially stressful complication of cataract surgery, which can lead to a clearing of a pre-existing clinical picture of dry eye.
It is therefore essential, before cataract surgery, to avoid post-operative dry eye syndrome:
- identify patients at risk
- optimize the ocular surface before surgery with adequate therapy
- use intraoperative strategies to minimize damage to the ocular surface
- optimize the results of surgery through post-operative management