Dry eye and cataract surgery: Narrative review and recommendations for management

Cataract surgery is the most frequently performed surgical procedure in the elderly in Western countries and patients' expectations for postoperative outcomes are very high. Dry eye disease (DED) is a common multifactorial symptomatic disease of the ocular surface with a complex etiopathogenesis and a prevalence significantly increasing with age. Cataract surgery and DED have a complex relationship, which needs to be acknowledged, understood, and properly managed, as suggested by daily clinical experience and growing scientific evidence. The surgical procedure can have a relevant impact on the tear film and the ocular surface, and it can, usually transiently, induce or exacerbate DED symptoms. Moreover, preoperative DED can affect surgical refractive outcomes, while postoperative DED symptoms can significantly worsen patients reported outcomes and satisfaction. At the end of this narrative review summarizing the evidence on this topic, the "Dry Eye and Cataract Surgery" subcommittee of the DROPS workshop formulated some recommendations for ocular surface and DED management pre-, intra-, and post-cataract surgery.