Here in Miami and probably elsewhere, about half of my patients having cataract surgery also have dry eyes or eye allergies or various types of inflammation of the eyelids.  It is amazing to me how this problem can reduce the good results of well done cataract surgery (LASIK surgery as well).  In many cases the condition is only slightly bothersome prior to surgery, however, when you have cataract surgery with one of these ocular surface diseases present, there appears to be a surprising diminusion of the visual outcome.  If you have chosen to make a significant “lifestyle enhancement” with a multifocal lens insertion at the time of cataract surgery you want to maximize the result and achieve the ultimate potential of this new technology. 

During the preoperative examination at Miami Eye Center, we look at the tear film using new technology and are able to determine if you have a deficiency in the water component of the tear film or if your tears are evaporating too fast.  When found, patients are treated with artificial tears preoperatively and the surgery itself is performed in a way which protects the surface of the cornea.  If we find an inflammatory problem causing a tear film deficiency we treat that with a course of cortisone eye drops before the surgery.  We might also use Restasis to decrease inflammation. In cases of eyelid inflammation a round of oral antibiotics as well as antibiotic eyedrops over a period of several weeks can improve the tear film.

The take home message here is that there are subtle issues which can impact the outcome of your eye surgery that are beyond just having a good procedure and your surgeon needs to evaluate these factors and discuss them with you.

Firstly, let us not refer to the condition as “dry eyes” rather “tear film deficiency” or “dysfunctional tear syndrome.”  The change in terminology reflects the updated understanding that the problem involves the entire lacrimal functioning unit as a whole and emphasizes tear film quality rather than tear volume.  In the past, the dry eye has been treated with the application of artificial tear alone to replace the volume, now the condition is recognized as an inflammatory disease and treatment is directed at the inflammatory component.

Tear film deficiency is extremely common with the incidence anywhere from 4% to 15% of the population over the age of 45 years and it is more prevalent in woman. 

 What causes this tear problem?  The lacrimal functional unit consists of the lacrimal gland (tear gland), the surface of the eye itself and the nerve connections between the two which passes through the brain.  When the cornea is not happy with the quality of tears, it sends a message to the brain which tells the lacrimal gland to get busy.  The lacrimal gland produces the tears which contain growth factors and other proteins.  In addition, the surface of the eye contributes lipids which reduce evaporation and mucins which enhance the spread of the tears on the eye.  The currently available studies indicate that the symptoms are related to inflammation of the ocular surface and lacrimal gland which disrupts their function.

There are numerous conditions which influence the development and worsening of the dry eye such as LASIK surgery, glaucoma medications, inflammatory diseases such as rheumatoid arthritis and other systemic diseases such as diabetes and Parkinson’s Disease.  Antidepressants, diuretics, hormones and antihistamines among other drugs are implicated in worsening the condition.

Treatment is determined by the level of severity of the symptoms.  For those with mild, intermitent problems due to changes in the environment, the approach is to use over the counter artificial tear substitutes.  In general, I find that you get what you pay for when it comes to these products, that is, the inexpensive generic drops do not work.  Products such as Optive, Systane, Hypotears are most effective.  When the symptoms worsen where your activities are impacted then more aggressive treatment is indicated.  Firstly, you might consider taking omega-3 fatty acids for their anti-inflammatory effect.  If there is eyelid inflammation, you might require antibiotic eye drops.  Sometimes, in the short term, cortisone eyedrops for a limited period might break the cycle.  Eyedrops such as Restasis are effective in reducing the  inflammation of the lacrimal gland and ocular surface.  Silicone plugs (punctum plugs) placed in the tear drainage canal will allow the tears to remain on the eye for a longer time.  There are drugs which stimulate the lacrimal gland to produce more tears (secretogogues) which are sometimes helpful. 

If we think about tear film deficiency as an inflammatory disease we will be much more effective in treating the condition than in years past when we looked at it solely as a lack of tear volume.

If you would like to review your dry eye issues with me just give a call and I will be happy to give you my best opinion.