Study of the factors affecting dry eye following phacoemulsification

1. aim and objectives: To determine association of post phacoemulsification dry eye with various risk factors such as :

2. Baseline factors: age, gender, chronic illness, and medication they would be currently on.

3. Intraoperative factors: microscopic light exposure time, C.D.E., incision site of the main incision: temporal, supra temporal or infratemporal, type of anaesthesia used: sub tenon, peribulbar or topical.

4. Post-operatively: the different types of lubricating drops such as sodium hyaluronate, carboxymethyl cellulose eye drops, hydroxy propyl methyl-cellulose eye drops, or no eye drops at all.

2 . Methodology

In this study the following tests will be used to assess the dry eye symptoms at pre-op visit; at 2 weeks  and 1 and half month follow up post surgery .3 month follow up would be done for patient who are compliant for the follow up.

1. Schirmer’s test: type 1(ST-1)(to evaluate reflex and basal tear secretion}: The Schirmer test typically consists of a 35 * 5 mm strip of Whatman No. 41 filter paper that can be folded 5 mm from one end and is anchored to the patient’s lower eyelid. After 5 min, the amount of tear production is measured in millimeters; type 2:(to test basal tear secretion ) After Schirmer type 1, we instill anesthetic drops such as proparacaine eye drops and repeat the method of Schirmer’s type 1 measuring the amount of tear production in millimetres.
2. TBUT:(to test tear film stability and Meibomian gland disorder) Fluorescein TBUT is one of the measures of tear film stability. It is performed by moistening a fluorescein strip with sterile non-preserved saline and applying it to the inferior tarsal conjunctiva. The precorneal tear film is examined using a broad beam of the slit lamp with a blue filter. The time lapse between the last blink and the appearance of the first randomly distributed dark discontinuity in the fluorescein stained tear film is the TBUT. Breakup times less than 10 s are considered abnormal.
3. OSDI (Ocular Surface Disease Index)  questionnaire: This is used to assess the ocular symptoms associated with dry eye disease from symptoms to visual disturbances. The 12-item questionnaire assesses dry eye symptoms and the effects it has on vision-related function in the past week of the patient’s life. The questionnaire has 3 subscales: ocular symptoms, vision-related function, and environmental triggers. Patients rate their responses on a 0 to 4 scale with 0 corresponding to “none of the time” and 4 corresponding to “all of the time.” A final score calculated ranges from  0 to 100 with scores 0 to 12 representing normal, 13 to 22 representing mild dry eye disease, 23 to 32 representing moderate dry eye disease, and greater than 33 representing severe dry eye disease.
4. Lissamine green staining of cornea and conjunctiva:conjunctival staining using lissamine green was observed at least 1 minute but no more than 4 minutes after the instillation of dye through slit-lamp examination under dimmed white light.