Abstract

Background: Cataract surgery is the most frequent surgical procedure in the world.1 Even though excellent postoperative recovery for the majority patients (visual acuity 10/10), dry eye may lead to symptoms of ocular irritation and a change in quality of vision.1The development or aggravation of signs and symptom of dry eye after cataract surgery is multifactorial which can be due to inflammation, loss of  goblet cells, lacrimal under secretion, eye drop toxicity and decrease in corneal sensitivity. MGD is the main cause of dry eye syndrome due to over evaporation. Its prevalence varies from 20 to 60%.1 MGD is a chronic, diffuse condition of Meibomian glands, which is characterized by obstruction of the terminal canals and/or changes in the Meibum.

Objectives: To identify Meibomian Gland Dysfunction and it’s association with dry eye symptoms in patients undergoing cataract surgery. 

Method: Patients who were admitted in tertiary care centre during study period of 18 months for cataract surgery were included. Patients having systemic diseases or on medications that cause dry eye, undergone any ocular surgery, trauma, herpes infection in past 3 months, having lid abnormality or any active ocular inflammation and paediatric cataract case were excluded. For each patient visual acuity was taken. Complete slit lamp bio-microscopy examination and Funduscopy done.

All study participants were evaluated for Meibomian gland dysfunction by examining for following findings: Meibomiangl and secretion, Meibomian gland plugging, bulbar conjunctival redness, lid margin redness, lid margin debris and tear film break up test. Schirmer’s test was done.

Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire was filled for every patient and the score was calculated.

Result: Out of 261 patients 109 were male and 152 were female. Considering the SPEED score >8 significant for dry eye, total 52 patients were having dry eye and 209 patients were below the range of dry eye. 139 patients were having MGD score <2, 114 patients were having MGD score >2 and 8 patients were having MGD score >8. On schirmer test examination, 2 patients were having <5 mm, 53 patients were having 5-10 mm and 206 patients were having >10 mm. On considering the MGD score and SPEED score, there was statistically significant association between them, with sensitivity of 80.77. Cut of value (1.5) of MGD Score decided using Youden Index, which indicates that sensitivity was 80.8% and specificity was 42.5%. 

It has been observed that the mean age was higher in >8 MGD score group which was statistically significant. And also the mean age was higher in >8 SPEED score group which was statistically significant. Prevalence of MGD increases with age.

Conclusion: The study shows significant association of MGD and Dry eye in patients undergoing cataract surgery. Dry eye disease and MGD are common diseases and prevalence significantly increases with age. Prophylactic preoperative testing for MGD should be routinely included in preoperative evaluation of Meibomiangl and function of cataract surgery patients.

Keywords: Cataract Surgery, Meibomian Gland Dysfunction (MGD), SPEED (Standard Patient Evaluation of Eye Dryness)