Eyeworld

EW CORNEA 78 December 2017 Investigating continued from page 77 Dry eye related to ophthalmic surgery There's a growing awareness of the importance of treating dry eye and ocular surface disease (OSD) be- fore and after ophthalmic surgery. Common ophthalmic surgeries mentioned in the report include LASIK, PRK, cataract surgery, and lid surgeries. The report reinforces the message of managing the ocular surface for dry eye before these procedures—a message that Inna Ozerov, MD, Miami Eye Institute, Hollywood, Florida, appreciates. "I'm very particular about treating dry eye prior to cataract sur- gery," Dr. Ozerov said. "Dry eye dis- ease can adversely affect our preop surgical measurements, leading to inaccurate results. Post-cataract surgery patients are also managed aggressively. In the days of refractive cataract surgery, dry eye patients will be unhappy with ocular surface disease that is not managed." Dr. Gomes and co-authors also review several other ocular surgeries that can induce dry eye, including keratoplasty, conjunctival surgery, and glaucoma surgery. The authors stressed the importance of preop dry eye screening and treatment, intraop techniques such as gentle manipula- tion and secure wound closure, and considering earlier and more aggres- sive use of laser trabeculoplasty in glaucoma patients with pre-existing OSD. In patients with diabetes, strict blood sugar control should be opti- mized before surgery, and epithelial debridement should be avoided if possible. "If an epithelial debride- ment is performed, use of a bandage contact lens postoperatively will aid in epithelial healing," they wrote. Other procedures The DEWS II iatrogenic report ad- dressed several other procedures or medical treatments that may induce or exacerbate dry eye, including: • Botulinum toxin injections • Corneal crosslinking • Cosmetic procedures (including permanent eye makeup, eyelash growth products, fillers, conjuncti- val whitening, eye tattooing, and jewelry/piercings) • Positive pressure noninvasive ven- tilation for obstructive sleep apnea • Radiation treatment Dr. Park was pleased to see cosmetic eye whitening mentioned. "We have known this is extreme- ly dangerous, with a high risk of complications, of which dry eye is only one. This was reiterated in the report," she said. Although Dr. Ozerov was not surprised by the report's overall find- ings, she still thinks it's a valuable read. "I loved how comprehensive it is. The report explores all facets of dry eye disease in a systemic fash- ion," she said. There are several areas import- ant for future research related to iatrogenic dry eye, the authors said. The establishment of more preser- vative-free topical drugs, systemic drugs that minimize side effects like dry eye, a better understanding of contact lens-induced dry eye, and research that pinpoints causes of surgical-induced dry eye are just some of the areas valuable for future exploration, they wrote. EW Reference 1. Gomes JAP, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15:511–538. Editors' note: The physicians have no financial interests related to their comments. Contact information Gomes: japgomes@uol.com.br Ozerov: iozerov@gmail.com Park: jr3674@cumc.columbia.edu Are you a fan of EyeWorld? Find us on Facebook at facebook.com/ EyeWorldMagazine

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