Cataracts & Dry Eye Treatment – James S. Lewis, MD
Serving Philadelphia, Bucks County, Delaware Valley, King of Prussia, Warminster, Conshohocken, Phoenixville and Montgomery County
Many of our Pennsylvania cataract surgery patients also have dry eye syndrome. This can be a relatively minor level or surface irritation, foreign body sensation, tearing, and fluctuating vision. Sometime, it is a sight-threatening condition associated with collagen vascular disease. Another group of patients that suffer from keratoconjunctivitis sicca have rosacea, blepharitis, or other tear film abnormalities.
For optimal results, dry eye should be addressed before any intraocular surgery is performed. Sometimes this is little more than the use of warm compresses and artificial tears. Other times it involves topical cyclosporin (Restasis), tear enhancement by punctal occlusion, vitamin supplements including fish oil, oral Doxycycline, or IPL laser treatment for dry eye.
On rare occasions lid position and function must be changed by an oculoplastic surgeon before safe cataract surgery can be performed. Also, endocrinologists, rheumatologists, and family physicians may need to administer systemic agents to achieve a successful procedure and good vision.
We pioneered tear enhancement by punctal occlusion 25 years ago using thermal cautery, laser punctoplasty, and our own temporary punctal plugs. We performed the clinical trails for 4-month absorbing punctal plugs and were the first to recommend insertion on every refractive surgery patient. We were using topical cyclosporine for dry eye even before it was manufactured by Allergan as Restasis. Finally, we are the first practice in tri-state area to perform IPL-laser for dry eye.
Cataract patients are evaluated and tested for dry eye. Treatment is begun and results achieved prior to intraocular surgery. This not only improves the patient’s comfort, it maximizes the safety of the surgery and the final visual results.