Comparison of clinical and inflammatory markers for dry eye disease following phacoemulsification and manual small incision cataract surgery

Dry eye disease(DED) is currently defined as a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation and neurosensory abnormalities play etiological roles. The new DED definition puts more emphasis on the homeostasis of the tear film and diagnostic homeostasis marker tests. A recommended work up for DED includes screening with a questionnaire and homeostasis markers (non-invasive tear break-up time, osmolarity and staining) in which case DED is diagnosed if the patient has symptoms and one of the homeostasis markers is positive even without the full battery of recommended tests. Cataract surgery has been shown to be responsible for transiently inducing or exacerbating dry eye; studies have shown uncomplicated phacoemulsification can increase dry eye symptoms but generally the symptoms resolve after about 3 months. The signs associated with post-cataract dry eye include decrease in tear break up time, increase ocular surface staining and changes in tear volume. There have been a few studies from India demonstrating the pattern of dry eye after cataract surgery. MSICS is one of the most commonly performed cataract surgeries in our country and is gradually being adopted worldwide. This study will help us know the incidence of DED after MSICS and phacoemulsification and if there a difference depending on surgical technique used viz. MSICS versus phacoemulsification. By calculating the incidence and pattern of dry eye after cataract surgery, we could develop new therapeutic strategies to reduce and treat post-operative dry eye more effectively.

Hypothesis: Patients undergoing cataract surgery by MSICS have greater occurrence and extent of dry eye disease as compared to phacoemulsification.