Effects of cataract surgery on symptoms and findings of dry eye in subjects with and without preexisting dry eye



To compare dry eye symptoms and findings in post cataract surgery eyes’ with and without preexisting dry eye.

Study design

Prospective, observational case–control study.


Sixty-seven eyes that had undergone cataract surgery were included; 48 were classified into group D (preexisting dry eye) and 19 into group N (no preexisting dry eye). No subjects received perioperative treatment for dry eye. We evaluated between-group differences in symptom scores, corrected distance visual acuity (CDVA), tear film breakup time (BUT), tear film breakup pattern (BUP), and ocular surface fluorescein staining scores, at 1 week, 1 month, and 3 months postoperatively.


Symptoms were unchanged in group N, but improved in group D (P < .001) postoperatively. CDVA was improved after surgery in both groups (P < .001). BUT was shorter preoperatively in group D than in group N although this difference was absent 1 month postoperatively. Fluorescein staining scores significantly increased at 1 month postoperatively in group N (P = .01), but did not change in group D. During the perioperative period, the predominant BUP was the random break pattern in both groups (≥ 85%). From 1 week to 3 months, dimple break patterns decreased in group D (P = .007), whereas spot break patterns increased (P = .01).


Cataract surgery has an influence on tear film stability and the ocular surface. There was either a transient improvement or worsening of ocular surface wettability in some patients without preexisting dry eye.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15:276–83.

    Article  Google Scholar 

  2. 2.

    Tsubota K, Yokoi N, Shimazaki J, Watanabe H, Dogru M, Yamada M, et al. Asia Dry Eye Society: new perspectives on dry eye definition and diagnosis: a consensus report by the Asia Dry Eye Society. Ocul Surf. 2017;15:65–766.

    Article  Google Scholar 

  3. 3.

    Shimazaki J, Yokoi N, Watanabe H, Amano S, Ohashi Y, Kinoshita S, et al. Definition and diagnosis of dry eye in Japan, 2016. Atarashii Ganka. 2017;34:309–13 (in Japanese).

    Google Scholar 

  4. 4.

    Shimazaki J. Definition and diagnostic criteria of dry eye disease: historical overview and future directions. Invest Ophthalmol Vis Sci. 2018. https://doi.org/10.1167/iovs.17-23475.

    Article  PubMed  Google Scholar 

  5. 5.

    Vehof J, Kozareva D, Hysi PG, Hammond CJ. Prevalence and risk factors of dry eye disease in a British female cohort. Br J Ophthalmol. 2014;98:1712–7.

    Article  Google Scholar 

  6. 6.

    Jiang D, Xiao X, Fu T, Mashaghi A, Liu Q, Hong J. Transient tear film dysfunction after cataract surgery in diabetic patients. PLoS ONE. 2016;10:1371–8.

    Google Scholar 

  7. 7.

    Oh T, Jung Y, Chang D, Kim J, Kim H. Changes in the tear film and ocular surface after cataract surgery. Jpn J Ophthalmol. 2012;56:113–8.

    Article  Google Scholar 

  8. 8.

    Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009;23:65–73.

    Article  Google Scholar 

  9. 9.

    Park Y, Hwang HB, Kim HS. Observation of influence of cataract surgery on the ocular surface. PLoS ONE. 2016;11:e0152460.

    Article  Google Scholar 

  10. 10.

    Li XM, Hu L, Hu J. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007;26:S16–20.

    Article  Google Scholar 

  11. 11.

    Yokoi N, Georgiev GA. Tear-film-oriented diagnosis for dry eye. Jpn J Ophthalmol. 2019. https://doi.org/10.1007/s10384-018-00645-4.

    Article  PubMed  Google Scholar 

  12. 12.

    Yokoi N, Georgiev GA, Kato H, Komuro A, Sonomura Y, Sotozono C, et al. Classification of fluorescein breakup patterns: a novel method of differential diagnosis for dry eye. Am J Ophthalmol. 2017;180:72–85.

    Article  Google Scholar 

  13. 13.

    Sakane Y, Yamaguchi M, Yokoi N, Uchino M, Dogru M, Oishi T, et al. Development and validation of the dry eye-related quality-of-life score questionnaire. JAMA Ophthalmol. 2013;131:1331–8.

    Article  Google Scholar 

  14. 14.

    Koh S, Watanabe H, Hosohata J, Hori Y, Hibino S, Nishida K, et al. Diagnosing dry eye using a blue-free barrier filter. Am J Ophthalmol. 2003;136:513–9.

    Article  Google Scholar 

  15. 15.

    van Bijsterveld OP. Diagnostic tests in the sicca syndrome. Arch Ophthalmol. 1969;82:10–4.

    Article  Google Scholar 

  16. 16.

    Koh S, Tung CI, Inoue Y, Jhanji V. Effects of tear film dynamics on quality of vision. Br J Opthamol. 2018;102(12):1615–20.

    Article  Google Scholar 

  17. 17.

    Uchino M, Dogru M, Yagi Y, Goto E, Tomita M, Kon T, et al. The features of dry eye disease in a Japanese elderly population. Optom Vis Sci. 2006;83:797–802.

    Article  Google Scholar 

  18. 18.

    Dougherty BE, Nichols JJ, Nichols KK. Rasch analysis of the Ocular Surface Disease Index (OSDI). Invest Ophthalmol Vis Sci. 2011;52:8630–5.

    Article  Google Scholar 

  19. 19.

    Gupta PK, Drinkwater OJ, VanDusen KW, Brissette AR, Starr CE. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018. https://doi.org/10.1016/j.jcrs.2018.06.026.

    Article  PubMed  Google Scholar 

  20. 20.

    Herbaut A, Liang H, Rabut G, Trinh L, Kessal K, Baudouin C. Impact of dry eye disease on vision quality: an optical quality analysis system study. Transl Vis Sci Technol. 2018;7:5.

    Article  Google Scholar 

  21. 21.

    Miyake K, Yokoi N. Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study. Clin Ophthalmol. 2017;11:529–40.

    CAS  Article  Google Scholar 

  22. 22.

    Yao K, Bao Y, Ye J, Lu Y, Bi H, Tang X, et al. Efficacy of 1% carboxymethylcellulose sodium for treating dry eye after phacoemulsification: results from a multicenter, open-label, randomized, controlled study. BMC Ophthalmol. 2015;15:28.

    Article  Google Scholar 

  23. 23.

    Sánchez MA, Arriola-Villalobos P, Torralbo-Jimenez P, Giron N, de la Heras B, Herrero Vanrell R, et al. The effect of preservative-free HP-Guar on dry eye after phacoemulsification: a flow cytometric study. Eye (Lond). 2010;24:1331–7.

    Article  Google Scholar 

  24. 24.

    Han KE, Yoon SC, Ahn JM, Nam SM, Stulting RD, Kim EK, et al. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol. 2014;157(1144–50):e1.

    Google Scholar 

  25. 25.

    Jiang D, Xiao X, Fu T, Mashaghi A, Liu Q, Hong J. Transient tear film dysfunction after cataract surgery in diabetic patients. PLoS ONE. 2016;11:e0146752.

    Article  Google Scholar 

  26. 26.

    Yinhui Y, Huixia H, Menghan W, Yibo Y, Wangshu Y, Kairan L. Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41:2614–23.

    Article  Google Scholar 

  27. 27.

    Ito M, Kawaoto H, Nakayoshi T. Toxicological studies of PVP-1 II. Twenty-eight-day repeated oral toxicity study in rats. Environ Infect. 1999;14:247–54 (in Japanese).

    Google Scholar 

  28. 28.

    Starr CE, Gupta PK, Farid M, Beckman KA, Chan CC, Yeu E, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669–84.

    Article  Google Scholar 

  29. 29.

    Koh S, Maeda N, Kuroda T, Hori Y, Watanabe H, Fujikado T, et al. Effect of tear film break-up on higher-order aberrations measured with wavefront sensor. Am J Ophthalmol. 2002;134:115–7.

    Article  Google Scholar 

  30. 30.

    Koh S, Maeda N, Ogawa M, Asonuma S, Takai Y, Maruyama K, et al. Fourier analysis of corneal irregular astigmatism due to the anterior corneal surface in dry eye. Eye Contact Lens. 2019;45:188–94.

    Article  Google Scholar 

Download references


N. Maeda, Grant (Japanese Ministry of the Education, Culture, Sports, Science and Technology and Japanese Ministry of Health, Labor and Welfare)

Author information




Study concept and design (MS, NM, SK, KA, RK, KN); data collection (MK, KA, RK); analysis and interpretation of data (MS, NM, SK, KA, RK, KN); writing the manuscript (MS, NM, SK); critical revision of the manuscript (MS, NM, SK, KA, RK, KN). All authors read and approved the final manuscript.

Corresponding author

Correspondence to Naoyuki Maeda.

Ethics declarations

Conflicts of interest

M. Shimabukuro, None; N. Maeda, Lecture fee (AMO, Alcon, Bausch + Lomb, HOYA, Oculus, Santen, Senjyu, Tomey, Menicon, Pfizer); S. Koh, Grant (Seed); K. Abe, None; R. Kobayashi, None; K. Nishida, Grant and Lecture fee (Senjyu, Otsuka, Santen), Grant, Lecture fee and Consultant fee (Novartis).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Naoyuki Maeda

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shimabukuro, M., Maeda, N., Koh, S. et al. Effects of cataract surgery on symptoms and findings of dry eye in subjects with and without preexisting dry eye. Jpn J Ophthalmol 64, 429–436 (2020). https://doi.org/10.1007/s10384-020-00744-1

Download citation


  • Cataract surgery
  • Dry eye
  • Tear film breakup pattern
  • Tear film breakup time