The use of tear osmolarity as a diagnostic tool for detection of dry eye prior to cataract surgery

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To determine if the diagnosis of preoperative dry eye can help to improve outcomes following cataract surgery.


This was a prospective that enrolled cataract patients scheduled to undergo standard phacoemulsification surgery followed by placement of an intraocular lens. Patients were assessed for the presence of dry eye before surgery, and then at one week and one month after surgery. Tests used were tear break-up time (TBUT), Schirmer’s, and tear osmolarity (TearLab Corp, San Diego, CA). All patients were placed on a standard postoperative treatment regime of topical steroids, non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics for one month following surgery.


Twenty-five patients were enrolled in the study. The mean preoperative tear osmolarity was 304.6 mOsm/L Twelve patients had preoperative dry eye, defined as a tear osmolarity level greater than 308 mOsm/L. Mean osmolarity remained stable at the 1st postoperative visit. At the one-month postoperative visit, the mean osmolarity was 297.4 mOsm/L.


The results suggest that conventional means of dry eye testing may miss patients with preoperative dry eye, compared to osmolarity testing, which provides an objective measurement. The lower postoperative osmolarity levels seen in this study were no doubt related to the postoperative medication regimen and it would be reasonable to expect that the osmolarity measurement would return to baseline after treatment stopped.

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