Impact of Cataract Surgery Steps on Postoperative Dry Eye Disease: A Narrative Review.

INTRODUCTION: Dry Eye Disease (DED) is a common multifactorial condition exacerbated by cataract surgery. This review explores how each step of cataract surgery may contribute to postoperative DED. METHODS: A narrative review was conducted examining preoperative, intraoperative, and postoperative factors implicated in the development and severity of DED following cataract surgery. RESULTS: Preoperative assessments reveal a high prevalence of pre-existing, often undiagnosed, DED among cataract surgery candidates; the effect of dilating drops on tear film stability warrants further investigation. Intraoperatively, povidone-iodine irrigation, lid speculum use, corneal incision size and location, and prolonged ocular surface exposure disrupt ocular surface homeostasis. Postoperative antibiotics, steroids, and NSAIDs, particularly preserved formulations requiring frequent instillation, may further exacerbate dry eye symptoms. Symptom resolution parallels corneal nerve regeneration and stabilization of corneal aberrations, typically occurring within three months. Sodium hyaluronate improves postoperative tear film parameters, while ophthalmic viscosurgical devices and preservative-free drops may minimize DED risk. DISCUSSIONS: DED following cataract surgery results from cumulative surgical and pharmacologic exposures across the perioperative period. Preoperative screening and preservative-free regimens may reduce its incidence and severity.