Evaluation Of Changes In Tear Film Parameters And Blinking Rate In Patients Undergoing Cataract Surgery

Numerous studies show that anterior segment surgery can cause alterations in the pre-corneal tear film even in patients who do not present symptoms referable to dry eye before surgery. Our aim is to evaluate blinking, tear film production and stability, and symptoms in the 8 weeks following cataract surgery compared to baseline.

Multicenter study carried out by the Ophthalmology Unit of the University Hospital of Salerno and by the University of Naples Federico II.

125 eyes of 125 subjects (61M , 64F; mean age 68.7 +/- 7.4) underwent SLE (NEI score), dry eye analysis with TearCheck® (NIBUT, tear meniscus, meibography), Schirmer test 1, and DED questionnaires (OSDI score) at baseline (T0), 1 week (T1), 4 weeks (T2) and 8 weeks (T3) after cataract surgery. All the patients received the same postoperative treatment with antibiotics/steroids QID for 2 weeks and NSAIDs BID for 4 weeks. Exclusion criteria: topical therapies in the last three months, previous keratitis, previous ocular surgery, neurological diseases, diabetes mellitus, operative (capsular ruptures, vitrectomy, hemorrhages) or postoperatively (persistent corneal edema, infections, hypertonia, need for additional therapies) complications.

NEI score: T0 2.2 +/- 0.7, T1 5.7 +/- 1.1, T2 5.1 +/- 1.2, T3 4.8 +/- 0.8; NIBUT: T0 5.3 +/- 1.3 sec; T1 3.7 +/- 0.9 sec, T2 3.6 +/- 0.6 sec; tear meniscus: T0 0.33 +/- 0.09, T1 0.16 +/- 0.04, T2 0.15 +/- 0.07, T3 0.21 +/- 0.1; meibography T0 38.6 +/- 6.3%, T1 59.8 +/- 9.2 %, T2 61.2 +/- 8.8 %, T3 57.6 +/- 7.1 %; blinking T0 12.2 +/- 5.4, T1 7.4 +/- 3.2, T2 6.6 +/- 2.8, T3 5.8 +/- 1.6; abortive blinking T0 19.3 +/- 4.6%, T1 47.6 +/- 10.2, T2 44.8 +/- 9.5, T3 46.2 +/- 8.8; schirmer test 1: T0 13.9 +/- 3.8, T1 7.9 +/- 3.5, T2 8.2 +/- 3.8, T3 8.9 +/- 4.1; OSDI T0 20.6 +/- 8.2, T1 39.0 +/- 9.6, T2 43.4 +/- 10.7, T3 36.8 +/- 6.9.

Statistically significant (p<0.05)  subjective-objective worsening of all tear parameters, post-operative reduction in the rate of blinking, worsening of the ocular protection index and fluotest were detected regardless of a pre-operative dry eye condition. In the literature, the reduction of NIBUT is generally correlated with an increased blink rate, with a compensatory effect; the reduction in blinking frequency detected after cataract surgery further aggravates dry-eye conditions. Adequate post-operative therapy with tear substitutes is therefore necessary.