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    Add as Friendpost catarct tearfilm dysfunction

    by: Rahul

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    1 : Tear Film Dysfunction in Post-Cataract Situation
    2 : Cataract and Cataract Surgery Cataract is characterized by opacification of lens resulting in alteration of vision Although there is medical care, surgery is indicated if cataract formation has reduced visual acuity to the level that it interferes with the patient's lifestyle and everyday activities Commonly employed Cataract surgeries are: Extracapsular cataract extraction by phacoemulsification Extracapsular cataract extraction by nuclear expression Intracapsular cataract extraction As any other sugary, cataract surgery is also associated with complications Optometric clinical Practice guideline. Care of the Adult Patient with Cataract. Available at: http://www.aoa.org/documents/CPG-8.pdf
    3 : Complications Following Cataract Surgery Cataract surgery and common complaints associated with it: Calvin W. Roberts, Eleanor R. Elie, J. Amer. Soc. Ophthal. Reg. Nur. 2007; 15: Vol. XXXII, No. 1 http://www.rila.co.uk/issues/free/001/2001/v4n2/p71_75/p71_75.html
    4 : Prevalence of Dry eye post cataract surgery The Importance of Managing the Ocular Surface in Cataract and Refractive Surgery. Available at: http://www.eyeworld.org/replay/08chicago/pdfs/6/08chicago-6-holland-PreoperativeEvaluation.pdf Dry Eye: A Common Complaint Following Cataract Surgery
    5 : How Cataract Surgery Causes Dry Eye?
    6 : Causes of Dry Eye Following Cataract & Refractive Surgery Surgical trauma Lack of lubrication Epithelial defects Suction ring pressure (LASIK) Lagophthalmos Altered corneal curvature Altered anatomic relationship between lid and cornea Inflammation Exposure to medications/anesthetics Trauma to sensory nerves Incisions, flap, photoablation Decreased corneal sensation The Importance of Managing the Ocular Surface in Cataract and Refractive Surgery. Available at: http://www.eyeworld.org/replay/08chicago/pdfs/6/08chicago-6-holland-PreoperativeEvaluation.pdf
    7 : Possible Mechanisms of Dry Eye Following Cataract Surgery The Importance of Managing the Ocular Surface in Cataract and Refractive Surgery. Available at: http://www.eyeworld.org/replay/08chicago/pdfs/6/08chicago-6-holland-PreoperativeEvaluation.pdf
    8 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Deterioration in corneal sensitivity and tear physiology Deterioration in corneal sensitivity and tear physiology is seen immediately after phacoemulsification. Induces greater and more prolonged damage to corneal sensation and corneal barrier function Corneal sensitivity does not return to preoperative levels until 3 months Causes prolonged increase in corneal epithelial permeability Surgery results in decrease of tear film stability Ophthal Physiological Optics. 2008;28(2):127–134; Am J Ophthal. 2005;139(1):64–71.
    9 : Most corneal surgical procedures, including phacoemulsification, disrupt the normal organization of corneal innervation Denervation of the cornea results in increased corneal sensitivity threshold causing: reduction in tear flow decrease in blinking frequency impaired wound healing & longer re-epithelialization period increased epithelial permeability decreased epithelial metabolic activity M Kohlhaas, J Cataract Refract Surg-Vol 24, Oct. 98 Corneal Sensitivity Post-Phacoemulsification
    10 : Corneal Sensitivity Post-Phacoemulsification Study Design In a prospective study of 48 patients, Kohlhaas and coauthours examined the development of corneal sensitivity after phacoemulsification Intraoperatively, 6-7 mm tunnel incisions were made at 12 o’clock, 2-3 mm from limbus. Preoperatively & postoperatively, corneal sensitivity was measured in the corneal centre and the limbal region at 12 & 6 o’clock The preoperative measurement of corneal sensitivity showed normal threshold values of 2.33 X 10-5 N in the centre, 11.37 X 10-5 N at 12 o’clock, and 11.67 X 10-5 N at 6 o’clock These values are comparable to those found in previous studies that examine central age-related threshold values between 0.8 & 2.5 X 10-5 N and peripheral values in vertical direction of up to 38 X 10-5 M Kohlhaas, J Cataract Refract Surg-Vol 24, Oct. 98
    11 : Study Result The highest postoperative increase in the sensitivity threshold values could be observed at 12 o’clock, directly below the corneal incision after preparation of the tunnel Up to 4 months postoperatively, this area showed marked hyposensitivity, almost corresponding to anesthesia. It was still hyposensitive after 1 year The corneal centre also showed continuous increase in sensitivity threshold Surprisingly even the threshold values found at 6 o’clock, far from tunnel incision, indicated hyposensitivity All threshold values, even at 6 o’clock were still hyposensitive after 1 year Increase in corneal sensitivity threshold after phacoemulsification via a scleral tunnel incision of 6mm. Measuring point 12 o’clock, approx. 1mm from the limbus, corneal centre, 6 o’clock, approx. 1mm from the limbus M Kohlhaas, J Cataract Refract Surg-Vol 24, Oct. 98
    12 : The opening of the conjunctiva & the cauterization of the episcleral vessels in the sclera & limbal area involve a dissection of the circumcorneal network This network sends out myelinated nerve fibers that run into the cornea superficially and stromally, forming a radial innervation By preparation of a tunnel or a corneoscleral dissection, these nerves are also dissected The circumcorneal nerve fiber network plays an important role in the sensitivity of the whole cornea Injuries or surgical incisions seem to involve major impairment of this network, associated with long-term effect on corneal sensitivity Factors effecting corneal sensitivity M Kohlhaas, J Cataract Refract Surg-Vol 24, Oct. 98
    13 : Impact of reduced corneal sensitivity Jordan & Baum reported a reduction in tear flow in anesthetized cornea Beuerman and Schimmelpfennig observed a decrease in blinking frequency in eyes with denervated cornea Affects 2 other protective mechanisms A marked reduction in mitosis rate in denervated corneal epithelial tissue A clear reduction in epithelial wound healing & longer re-epithelialization period of denervated cornea In addition, a reduction in corneal metabolism & increased permeability of corneal epithelium were also observed M Kohlhaas, J Cataract Refract Surg-Vol 24, Oct. 98
    14 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Changes in tear film and tear secretion Cataract surgery results in alteration of tear physiology resulting in decreased lacrimal production. Cataract surgery may results in damage to innervations to lacrimal gland, conjunctiva, lacrimal gland and goblet cells. Conjunctival damage caused by suction ring application may cause dry eye symptoms Significantly lower tear film break-up time (TBUT) is observed following cataract surgery. J Zhejiang Univ Sci B. 2008;9(4):324–328.
    15 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Changes in tear film and tear secretion J Zhejiang Univ Sci B. 2008;9(4):324–328.
    16 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Alteration of width of lacrimal river line Decreased width of lacrimal river is observed following cataract surgery Cataract surgery results in narrowing of the lacrimal river line up to <0.3 mm resulting in dry eye syndrome Normal width of lacrimal river before cataract surgery Decreased width of lacrimal river after cataract surgery Cornea. 2007;26(Suppl. 1):S16–S20.
    17 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Van Bijsterveld score increases after Cataract Surgery Van Bijsterveld score represents the severity of dye eye symptoms and damage to eye Cataract surgery causes significant increase in Van Bijsterveld score Cornea and conjunctiva fluorescein staining is positive in patients who underwent cataract surgery Fluorescein staining spots on cornea and conjunctiva is seen after cataract surgery. Cornea. 2007;26(Suppl. 1):S16–S20.
    18 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Van Bijsterveld score increases after cataract surgery Average van Bijsterveld score before and after cataract surgery. Fluorescein staining spots on cornea Cornea. 2007;26(Suppl. 1):S16–S20.
    19 : Dry Eye Symptoms in Relation to Common Cataract Surgeries Wound healing post phacoemulsification can trigger dry eye During wound healing difference in the wound healing response between superficial vs. deeper stromal wound models might result from interference of neural systems resulting in dry eye symptoms Lubrication is highly important to wound healing and the prevention of haze after refractive surgery. Thus, dry eye may delay wound healing after cataract surgery Ophthalmic Res. 2006;38:343–349.
    20 : Thus, cataract surgery results in structural changes and Physiological alterations causing dry eye symptoms In addition Dry eye also effects the quality of life significantly
    21 : Caring Patient Beyond Cataract Surgery Treatment of cataract surgery does not end with surgery. Its goals are much beyond that. The goals are To provide best possible postoperative visual acuity Decreasing foreign-body sensation, burning, and other symptoms occurring due to dry eye Improving the quality of vision (for example, by reducing the occurrence of blurry vision associated with ocular dryness) The Journal of the American Society of Ophthalmic Registered Nurses, 2007;32(1):14-23.
    22 : Dry Eye Can be a Hurdle in Providing the Best Patient Care Unfortunately dry eye is a commonest problem following cataract surgery Dry eye effects the patient significantly by effecting the recovery after surgery It also effects the quality of life Thus, it needs to be treated optimally based on the symptoms and cause of dry eye
    23 : Influence of Dry Eye on QoL Dry eye significantly affects the quality of life. 79% of people had difficulty in reading and 70% had difficulty in operating ATM or computers, according to a survey Traps of Dry Eye in Hong KongSurvey Report. Available at: http://hkupop.hku.hk/english/report/dryEye08/content/resources/presentation_eng.pdf
    24 : Why it is Important to Treat Dry Eye Following Cataract Surgery?
    25 : Dry Eye: Impact Dry eye can cause Weakened protective function, patients can feel more sensitive to environmental factors Severe dry eye can affect patients' social function, mental function, and even their confidence. Delayed wound healing Cornea. 2007;26(1):pp s16-s20.
    26 : Dry Eye: Impact The development of dry eye symptoms after cataract surgery may be a clinically significant phenomenon, with measurable impact on patient quality of life. Patient-reported symptoms of ocular discomfort are an important aspect of measuring the success of cataract surgery. Thus, managing dry eye following cataract surgery is essential to improve the outcomes of surgery and to achieve the goals of cataract surgery. The Journal of the American Society of Ophthalmic Registered Nurses, 2007;32(1):14-23.
    27 : Treatment of dry eye following cataract surgery It can improve the QoL It can quicken the wound healing process Tear secretion can increase the protection to eye It can improve the social well being of the patient In conclusion, treatment of dry eye following cataract surgery is important because
    28 : Summary Dry eye is a common complaint following cataract surgery It significantly affects the QoL of the patients It affects the normal tear physiology by damaging various tissues of eye It is an important hurdle in achievement of goals of cataract surgery treatment Thus it has to be treated with medications like artificial tears is helpful in the management of dry eye symptoms

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