Jayshree MP1, Shivkumar Hiremath1, Monalisha Pattnaik2* and Mallikarjun Salgar3
1Associate Professor, S.Nijlingappa Medical College and HSK Hospital, India
2Post Graduate Student, S.Nijlingappa Medical College and HSK Hospital, India
3Professor and Head, Department of Ophthalmology, S.Nijlingappa Medical College and HSK Hospital, India
Received: 08 June, 2017; Accepted: 05 July, 2017; Published: 06 July, 2017
Monalisha Pattnaik, Post Graduate Student, S.Nijlingappa Medical College and HSK Hospital, India, E-mail:
Jayshree MP, Shivkumar H, Monalisha P, Mallikarjun S (2017) A Prospective study of Dry Eye after manual Small Incision Cataract Surgery in rural population of Bagalkot. J Clin Res Ophthalmol 4(2): 025-029. 10.17352/2455-1414.000040
© 2017 Jayshree MP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Dry eye; Cataract surgery
Aim: To find the occurrence of ‘Dry Eye’ and to assess the severity of the dry eye after manual small incision cataract surgery with corneoscleral tunnel incision.
Material and Method: A total of 81 patients were selected who came for manual small incision cataract surgery. Each patient was questioned pre-operatively about ‘dry eye’ symptoms and examined with Schirmer’s test 1 and tear film break up time. Following this, the patients underwent small incision cataract surgery with a superior incision of 6-7mm depending on the grade of cataract. Schirmer’s test 1 and tear film break up time test were repeated on post-operative day 1st, 7th & 30th day. Dryness of the eye was analysed and graded as per DEWS classification 2007.
Result: In the total sample, 96.6% patient had dry eye. Among them 13.79% had mild grade and20.8%had moderate and 62.06% had severe grade. 37.93% were male and 65.5% were female. The mean age of patient was 58.18 with SD of 8.62.The difference in tear film break up time before and 7days after cataract surgery was found to be clinically significant with p value 0.0001, which stabilises and become clinically insignificant after 30 days (p value 0.215). The difference in Schirmer’s test before and 7days after cataract surgery was also found to be clinically significant with p value <0.01 and which becomes clinically insignificant after 30days with p value 0.111.
Conclusion: Tear film instability is a complication seen in early post-operative period of manual small incision cataract surgeries with corneoscleral tunnel. Such post-operative patients develop moderate to severe dryness of eye which improves after 1 month.
According to The International Dry eye Workshop the dry eye condition can be defined as a multifactorial disease of the tears and ocular surfaces that results in symptoms of discomfort, visual disturbances, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surfaces .
Dry eye is due to disturbance in lacrimal function unit, which comprises of the lacrimal gland, ocular surface, lid and the sensory and the motor nerves that connect to them. Damage to any component of the lacrimal function unit can destabilize the tear film and lead to ocular surface disease and visual disturbance .
Cataract is the most common cause of visual impairment in India. According to WHO cataract attributes to 51% blindness in India . Most common surgery done for cataract in developing country like India is small incision cataract surgery with corneoscleral tunnel. The incidence of dry eye after small incision cataract surgery range from 33.8% to 66.2% [4,5]. This study is done to evaluate the changes in tear film and tear production after small incision cataract surgery.
Material and Method
It is a longitudinal prospective study with sampling size of 81 patients, who came for manual small incision cataract surgery. Most of the patients in this study were from rural areas of Bagalkot.
• The Ethical committee had approved this study and written informed consent was taken from individual patients in their own language (Kannada).
• Inclusion criteria: Patients having unilateral or bilateral age related cataract with or without dry eye symptoms.
• Exclusion criteria:
1. Other than senile cataract
2. Pre-existing ocular diseases
3. Using contact lens
4. Patients on chronic ocular medication
5. Patients who underwent refractive surgery
6. Patients having ocular allergies, pterygium and blepharitis.
All the patients, pre-operatively were questioned about dry eye related symptoms like pricking, burning, and itching sensation and the observations were noted, following which slit lamp examination was done, Schirmer’s test-1,tear film break up time were evaluated. After all the investigations, the patient underwent small incision cataract surgery with a superior incision of 6-7mm.
The Schirmer’s test was done to assess the basal and reflex secretions of the tears. It was done by placing the schirmer’s strip, which was made up of Whatsmann no.41 filter paper with dimensions 5×35mm. The initial 5mm of the strip was folded and kept in the junction of the lateral 1/3rd and medial 2/3rd of the lower fornix of the operated eye for 5min. The wetting of the strip was noted using the scale present on the strip.
The tear film break up time assessment was done to assess the stability of the tear film. The tear film was stained by using sterile fluorescein strips 1% and under the slit lamp using cobalt blue filter, the time interval between the appearances of a 1stdark spot on the cornea after a complete blink was noted using a stop watch.
Before surgery all the patient were instilled ‘Tropicacylplus’ eye drops [tropicamide (0.8%)+ phenylephrine hydrochloride (5%)+ with benzalkonium chloride preservative 0.01%] 3times over an hour to dilate the pupil .After Peribulbar block with 4ml Lignocaine (2%) with1:100000 adrenaline + 2ml Bupivacaine (0.75%) + 150 units hyaluronidase. A 6-7mm superior partial thickness incision was taken and a 3 planar self-sealing tunnel was made and side port incision was taken at 9 O’clock position. The end of surgery side port was hydrated and subs conjunctival Gentamycin and dexamethasone was given at inferior fornix and eyes were patched for one day. The duration of surgery was approximately 20-30mins. Postoperatively all patients received topical TobaDM eye drops (tobramycin+ dexamethasone) hourly for 1week which was then tapered weekly over a duration of 1month and Ocuflur eye drops (flubiprofen) 4times a day for 1 month.