Dry eye after cataract surgery

Three things happen at once:

• • The corneal nerves that trigger normal tear production are briefly interrupted.
• • The ocular surface is inflamed — by the procedure itself and by the post-op drops.
• • Any dry eye that was already there, but not obvious, gets unmasked. Around 80% of people booked for cataract surgery already have some surface damage, whether or not they feel it.

More than 87% of patients are using artificial tears one month after cataract surgery. Femtosecond laser-assisted procedures carry a slightly higher risk of ocular surface staining than conventional phacoemulsification.

The nerves regrow, the surface calms down, and eye drops become an occasional thing. If your eyes were healthy before surgery and you're a few weeks post-op, giving it a bit more time — with a decent preservative-free drop and warm compresses — is often enough.

• • A proper assessment first — meibography, tear film analysis, surface staining. This tells us whether the problem is aqueous-deficient, evaporative, inflammatory, or a mix.
• • A preservative-free lubricating drop matched to your tear type, at the right frequency.
• • A short course of anti-inflammatory drops if the surface hasn't calmed down.
• • IRPL (Intense Regulated Pulsed Light) and meibomian gland expression if the oil layer is the bottleneck — one of the most useful tools for post-surgical evaporative dry eye.
• • Punctal plugs if tear volume is genuinely low.
• • Coordinating with your surgeon if you're still inside their follow-up window.

If you have cataract surgery on the horizon and you already know your eyes feel dry, get an assessment before the op. Two reasons:

1. Pre-existing dry eye distorts the measurements used to choose your lens implant. Fixing the surface first genuinely improves the visual outcome.
2. Going in with a stable ocular surface means the recovery is shorter and more comfortable.

Uncontrolled dry eye is a formal contraindication for refractive surgery for exactly this reason.