57
EW FEATURE
May 2017 • Treating the cornea before cataract surgery
cautioned. When staining, Dr. Hol-
land uses lissamine green, which can
stain abnormal conjunctiva, where-
as fluorescein only stains absent
epithelium.
A thorough slit lamp exam
should be a regular part of the dry
eye assessment as well. Dr. Holland
checks the eyelids for lagophthal-
mos, examines the conjunctiva,
and analyzes the lid margins. When
pushing on the meibomian glands,
what comes out should be free-flow-
ing, not opaque, paste-like, or hard
to express, he said. "All of these
things are done with a quick slit
lamp exam," he said.
"Schirmer I testing can provide
value, if performed correctly. A
1-minute Schirmer I measurement
multiplied by three provides a rea-
sonable estimate of the five-minute
result, and is much less irritating to
the patient," said Dr. de Luise.
Another test he recommends
is the Zone Quick Test, in which a
thread impregnated with phenol red
is placed in the outer lower con-
junctival sac for 15 seconds, and the
amount of tear wetting is measured.
Explaining to patients
If you find dry eye in patients, they
may be surprised to hear that their
cataract surgery can't proceed right
away.
"I wish all patients would have
good keratometry and topography
Lissamine green staining of the conjunctiva and cornea
Source: Vincent P. de Luise, MD, FACS
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