Pre-operative Dry Eye Management in Refractive Surgery : Supplemental Literature Review to the Previous Thesis

Abstract

Introduction: Dry eye is defined as a disease in international literature. In Finland, ophthalmologists do dry eye diagnoses. Also, general knowledge about dry eyes has recently been raised among optometrists and their patients. In the previous thesis: “Development of Dry Eye Service with Service Design” (Holappa, 2019), it became apparent that patients and professionals need strong motivation to keep caring for the ocular surface to diminish dry eye symptoms. This is especially important when the dry eye worsens because of healthcare interventions such as refractive surgery.

Purpose: This work aims to provide an overview of recent dry eye research based on the extensive literature review DEWS II (2017), which was the primary reference of the previous thesis. A new viewpoint on the topic was to consider what evidence is found in preoperative dry eye assessment and management.

Methods: This supplemental literature review used PubMed to search for systematic reviews in the last five years. The search combined the concepts of dry eye syndrome and refractive surgery.

Results: The review included five systematic reviews discussing preoperative dry eye assessment and/or management, published between 2020 and 2024. The original 63 studies of systematic reviews were conducted between 2010 and 2021. Based on this literature, applicable dry eye tests and management options should be considered before refractive surgery. This is especially critical for biometric measurements to calculate the power of the intraocular lens. Many assessment and management options have been investigated, but no standard remains in these studies. The results are described narratively and presented tabularly.

Conclusions: Optometry professionals performing preoperative screening for refractive surgery interested patients have a key role in guiding patients to take care of the ocular surface. Assessment is essential to solve the cause of the symptom and choose suitable treatment. Further education is needed to differentiate severe cases needing temporary dry eye medication. Those patients should be referred to an ophthalmologist and controlled before pre-examination of refractive surgery. Appropriate management would prevent dry eye symptoms from worsening after the operation and enhance patients’ satisfaction with the refractive outcome and quality of life.

Keywords: dry eye syndrome, meibomian gland dysfunction, MGD, ocular surface, dry eye management, refractive surgery, cataract surgery.