|Year : 2013 | Volume
| Issue : 4 | Page : 242-245
Dry eye risk factors after phacoemulsification cataract surgery at a secondary care hospital
Kamla Dodia1, Siddhesh Bapat1, Rajesh K Chudasama2
1 Department of Ophthalmology, Government Medical College, Rajkot, India
2 Department of Community Medicine, M P Shah Medical College, Jamnagar, Gujarat, India
|Date of Web Publication||7-Feb-2014|
Rajesh K Chudasama
Vandana Embroidary, Mato Shree Complex, Sardar Nagar Main Road, Rajkot - 360001, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Dry eye disease is no longer a trivial eye problem ignored by eye care professionals. Aim: The present study was conducted to detect dry eye problem level and evaluate risk factors associated with phacoemulsification cataract surgery. Settings and Design: Study conducted at Ophthalmology Department, Pandit Deendayal Upadhyay Medical College, Rajkot with longitudinal study design. Materials and Methods: The study included 272 patients undergone for phacoemulsification cataract surgery from May 2010 to April 2011, assessed for tear film status by tear film break up time (TBUT) and Schirmer's test on the pre-operative day, on the 1 st , 7 th and 45 th post-operative day. Statistical Analysis: statistical analysis was performed by using Epi Info software (Centre for Disease Control-CDC, Atlanta) with the use of proportions and z-test Results: On the 45 th post-operative day, 42 (15.4%) patients reported altered TBUT and Schirmer's I test (SIT) value indicating dry eye. Statistically significant difference was observed between TBUT and SIT value on day 1 and 7 when compared with pre-operative value. Maximum change in value was reported in both sexes above 65 years for 1 st and 7 th post-operative day. Similar findings were reported for TBUT value also. Conclusion: Phacoemulsification cataract surgery with higher age and female sex is associated with risk of dry eye. Significant percentage change of TBUT and SIT values reported during 1 st and 7 th post-operative day compare to pre-operative status.
Keywords: Dry eye, phacoemulsification, Schirmer′s I test, tear film break up time
|How to cite this article:|
Dodia K, Bapat S, Chudasama RK. Dry eye risk factors after phacoemulsification cataract surgery at a secondary care hospital. Int J Health Allied Sci 2013;2:242-5
|How to cite this URL:|
Dodia K, Bapat S, Chudasama RK. Dry eye risk factors after phacoemulsification cataract surgery at a secondary care hospital. Int J Health Allied Sci [serial online] 2013 [cited 2021 Jan 16];2:242-5. Available from: https://www.ijhas.in/text.asp?2013/2/4/242/126711
| Introduction|| |
Dry eye disease is no longer a trivial eye problem ignored by eye care professionals, under-diagnosed and undetected. The eye is a living optical system, the components of which keep on changing throughout life and one of the important components of it is the tear film and lacrimal system. If any of part of this system working inefficiently then it can lead to chronic problems. Abnormality in preocular tear film causes dry eye. The preocular tear film is a three layered structure consisting, from posterior to anterior, of the mucous, the aqueous and the lipid layers. The National Eye Institute/Industry Workshop on Clinical Trials in Dry Eye  defined dry eye as "a disorder of the tear film due to tear deficiency or excessive tear evaporation, which causes damage to the inter-palpebral ocular surface and is associated with symptoms of ocular discomfort."
Dry eye is the most frequent disorder in ophthalmology practice.  Studies have reported aggravation of dry eye symptoms and signs after cataract surgery. , The prevalence of dry eye varies from 4% to 57% thereby showing wide disparity throughout the world. ,,,, It is clearly viewed by patients as a chronic problem associated with a significant loss of quality of life, including chronic eye irritation and fluctuating vision. New understanding of pathogenesis of dry eye disease and emerging options for treatment have led to a broad-based interest in improving our approach to patient with dry eye. The present study was conducted with objective to detect dry eye problem level and evaluate risk factors associated with phacoemulsification cataract surgery in a secondary care hospital.
| Materials and Methods|| |
A prospective study was conducted at Ophthalmology department of Pandit Deendayal Upadhyay Medical College and Civil Hospital, Rajkot. The study was conducted for 1 year from May 2010 to April 2011 after taking ethical clearance from Institutional Ethical Committee. All patients admitted for phacoemulsification cataract surgery were enrolled for the study. During 1 year of the study period, total 272 patients were admitted in ophthalmology wards and included in the study after taking written consent.
An inclusion criterion includes all adult patients above the age of 18 years admitted for phacoemulsification cataract surgery. Exclusion criteria includes, all patients below 18 years of age, having a history of major medical and surgical illness, skin diseases, drug intake or drops, previous ocular operation, with some ocular disease, with a previous history of trauma, chemical burns, contact lens wear, other eye pseudophakia. All the study patients were enquired for ocular and systemic disease history. Every patient was subjected to detailed pre-operative assessment with a slit lamp biomicroscopy and fundoscopy. Intraocular pressure was measured with Schiotz tonometer and lacrimal passage patency by sac syringing. Then all the patients were subjected to Schirmer's I test (SIT) and tear film break up time (TBUT) examination. Both the test examinations were done on the pre-operative day, 1 st post-operative day, 7 th post-operative day and 45 th post-operative day and readings were noted. Objective tests comprised under room temperature conditions in order, each at 10 min interval to minimize reflex tearing and ocular surface changes secondary to testing. Precut strips for these tests were obtained from a government hospital supply from one supplier to maintain uniformity of results. A symptom score for Schirmer's test value <5 mm in 5 min on Whatman's filter paper no. 41 and for TBUT value <10 s were taken as indicators of dry eye.
Statistical P < 0.05 was considered as significant with 95% of the confidence interval. Epi Info version 3.5.1 was used to perform statistical analysis and appropriate statistical test (z-test) was used for analysis.
| Results|| |
A total of 272 patients were enrolled during the study period of 1 year. The mean age of 60.03 years was reported with 36-75 years range. [Table 1] shows baseline characteristics of all the study participants. More than half (54.4%) of the patients belongs to age group of 51-65 years. Female cases (55.9%) were reported more than male. Majority of patients (75.4%) residing in urban areas. At the end of the 45 th post-operative day, out of 272 patients, 42 (15.4%) were reported altered TBUT and SIT value indicating dry eye.
|Table 1: Baseline characteristics of 272 study participants undergone phacoemulsification cataract surgery|
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Comparison of pre and post-operative TBUT and SIT among study participants is shown in [Table 2]. The values are expressed as mean ± standard deviation. The TBUT value changes post-operatively on day 1 and day 7 remarkably. Statistically significant difference was observed between TBUT value on day 1 and day 7 when compared with pre-operative value. Similar findings were reported for the SIT value also.
|Table 2: Comparison of pre and post-operative TBUT and SIT among study participants|
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[Table 3] shows age and sex wise distribution of SIT value during the post-operative period after phacoemulsification cataract surgery. The comparison of post-operative SIT value was made against the pre-operative value and the changes shown as percentages. Maximum change in value was reported in both sexes for age group above 65 years for 1 st and 7 th post-operative day. Similar findings were reported for TBUT value also for both sexes and age group above 65 years [Table 4].
|Table 3: Age and sex wise distribution of SIT value during post-operative period after phacoemulsification cataract surgery|
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|Table 4: Age and sex wise distribution of TBUT value during post - operative period after phacoemulsification cataract surgery|
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| Discussion|| |
The present study was conducted to detect dry eye problem level and evaluate some risk factors associated with phacoemulsification cataract surgery in a secondary care hospital. The methods for dry eye diagnosis vary widely, undermining attempts at the definition by the use of differing diagnostic criteria and creating difficulties in comparisons of prevalence and efficacy of treatment regimens.  The reported high prevalence in some studies was also because objective dry eye tests have been performed in patients with positive symptom score (thereby introducing selection bias) or in patient with some diseases. 
The most common objective diagnostic test for dry eye, the Schirmer's test is used since a long time,  is inaccurate and unrepeatable because of reflex secretion produced by its invasive nature.  Due to the low cost of strips, their ease of application and the lack of availability of a more acceptable diagnostic test has led to the Schirmer test's being the most commonly applied clinical test for dry eye diagnosis. 
TBUT measurement with fluorescein is another widely used method for diagnosis of dry eye by ophthalmologists. The TBUT test is considered more reliable than the Schirmer test, as it is repeatable  and minimally invasive. However, the instillation of fluorescein can destabilize the tear film. , The measurement of break up time in the absence of fluorescein can overcome this problem and give a more accurate assessment of tear stability. 
The present study reported mean age of 60.03 years (range: 36-75) which was little low than the United Kingdom (63.8 years)  and Korea (67.5 years).  The prevalence of dry eye varies from 4% to 57% thereby showing wide disparity throughout the world. ,,,, Present study reported dry eye in 15.4% patients after 45 th post-operative day of phacoemulsification cataract surgery.
Phacoemulsification is currently used as a method for cataract surgery. However, the effects of this surgery on tear function including tear production and tear film stability are seldom studied. A study reported that phacoemulsification did not change TBUT and SIT scores in patients with dry eye,  while Liu et al. reported phacoemulsification reduced the TBUT in patients.  Present study reported changes in both TBUT and SIT compare to above studies.
Studies reported cases of dry eye increased progressively with age, ,, which is consistent with findings of our study. The present study reports dry eye cases more after 65 years of age and with increasing age restoration tear film is delayed. Significant correlation was reported by some study between age and dry eye. 
Many of the studies were reported a high number of dry eye cases in females than males. ,,, Present study also reported more number of dry eye cases in females. Menopause causes estrogen deficiency and a consequent change in local hormonal milieu of the lacrimal gland. It is thought to decrease tear production and occurrence of dry eye in females,  and that may be the reason for changes in more number of females.
| Conclusion|| |
Phacoemulsification cataract surgery is associated with risk of dry eye. Higher age and female sex is additional risk factor for the dry eye. At 45 th post-operative day, 15.4% patients were diagnosed with dry eye. More number of cases were reported in higher age group (>65 years) and in females. Significant percentage change of TBUT and SIT values reported during 1 st and 7 th post-operative day compare to pre-operative status.
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[Table 1], [Table 2], [Table 3], [Table 4]
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