EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1516463
56 | EYEWORLD | SPRING 2024 ATARACT C by Ellen Stodola Editorial Co-Director About the physicians D. Brian Kim, MD Professional Eye Associates Dalton, Georgia Rony Sayegh, MD Cole Eye Institute Cleveland Clinic Cleveland, Ohio F oreign body sensation (FBS) is a com- mon issue that may be associated with a wide range of conditions and may pres- ent with different signs and symptoms. Two physicians discussed this problem, including when they're most likely to see it and how to diagnose it. "It's difficult to guess percentage, but I think virtually all patients will experience some form of irritation at some point in their life including FBS, and in my experience, there is a specific subgroup, roughly 10%, who have a severe form that is recalcitrant to treatment," said D. Brian Kim, MD. The persistence of FBS implies chronicity, he said, which may include dry eye syndrome, blepharitis, or allergic conjunctivitis. Anatomical comorbidities involving the eyelid such as floppy eyelid syndrome, conjunctivochalasis, epithelial basement membrane dystrophy, and recurrent corneal erosions can exacerbate the problem as well. Rony Sayegh, MD, said that persistent FBS is when an individual experiences the sensa- tion that there is something gritty, scratchy, or uncomfortable in their eye, even when no actual foreign object is present. The prevalence of per- sistent FBS can vary depending on the under- lying causes and the population being studied, he said, adding that it's a relatively common complaint that ophthalmologists encounter. He also noted dry eye as one of the most common causes, affecting a significant portion of the population. How much does cataract surgery contribute? Dr. Sayegh said that FBS of varying severity, persisting for 3 or more months after cataract surgery, seems to occur in about 10–15% of patients. Although the mechanism is not fully understood, there are a number of possible rea- sons for this postoperative FBS, he said. Local edema over the incision from surgical trauma is one possible factor, and microcystic edema, or even frank bullae, can be seen on exam. Hypertonic saline solution can be helpful in these cases as the edema is often transient. Persistent inflammation is another cause that is not well understood. Patients with a his- tory of dry eye, diabetes, underlying connective tissue disease, or certain nutritional alterations may be at a higher risk. Damage to corneal nerves at the incision site is another potential cause. Severing corneal nerves can lead to alterations in the functional tear unit with decreased tear production, reflex tearing, and decreased release of neuroprotec- tive agents, all resulting in dry eye and damage to the ocular surface that can be perceived as Handling persistent foreign body sensation Local edema over the incision from surgical trauma is a possible reason for FBS after cataract surgery, and microcystic edema, or even frank bullae, can be seen on exam. Source: Rony Sayegh, MD This photo shows the thin profile of the Kim Corneal Sweeper and the well-demarcated fold in the epithelium highlighted by fluoresce- in dye and cobalt blue light. Source: D. Brian Kim, MD