Making a diagnosis of visually significant ocular surface disease before refractive cataract surgery should be a standard component of the pre-cataract workup.
We know there is a high prevalence of preexisting dry eye in the cataract population. Trattler and colleagues found upward of 60% of routine cataract patients were asymptomatic, yet 50% had central corneal staining. My colleagues and I reported the incidence of ocular surface disease in patients presenting for cataract surgery to be more than 80%, and in those who were asymptomatic, more than 50% had an abnormal tear osmolarity or MMP-9
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