The impact of cataract surgery on normal ocular surface: an experience from a tertiary center of southern region of Bangladesh

Abstract

Background: Ocular surface homeostasis and tear film stability can be compromised after cataract surgery, leading to dry eye disease (DED), whose incidence may vary widely and is often ignored as-a knowledge gap in Bangladesh.

Objective: To determine the frequency, severity, and predictors of tear film instability (DED) following age-related cataract surgery in a tertiary hospital in Bangladesh.

Methods: A prospective observational study was conducted at Chittagong Medical College Hospital (CMCH) from January 2022 to June 2023 among 113 patients aged ≥40 years undergoing small-incision cataract surgery or phacoemulsification. Patients with pre-existing DED or ocular surface disease were excluded. Tear Film Break-Up Time (TBUT) and Schirmer’s Test-1 (ST-1) were assessed before surgery and at 1 week, 1 month, and 3 months after surgery. Statistical analysis was performed using SPSS v25.0.

Results: Postoperative tear film instability peaked on day 7 (62.8%), declined to 39.8% on day 30, and was 12.4% on day 90 (p < 0.001). Mean TBUT and ST-1 values decreased significantly postoperatively but remained below baseline at 3 months. Incision length (p = 0.048) and longer microscope light exposure (p = 0.022) were independent predictors of tear film stability, while age, sex, surgical type, and cumulative dissipated energy (CDE) were not.

Conclusion: Cataract surgery causes a significant, but largely transient, reduction in tear film stability leading to DED, which peaks in the first postoperative week, with partial recovery by 3 months. Minimizing incision size and light exposure may reduce risk.