Dry Eye Can Occur After Surgery to Correct Crossed Eyes

Girls were more likely to develop dry eye after surgery, and nondominant eyes are more likely to develop postoperative dry eye.

Dry eye can occur as a temporary condition in children five to 12 years old who undergo surgery to treat strabismus, according to a new study published in Ophthalmology Therapy. Strabismus, commonly called crossed eyes, is a condition in which one eye is turned in a direction that is different from the other eye. Surgery is used to tighten or loosen eye muscles to align the position of the eyes. In the United States, the overall prevalence of childhood strabismus was 17.9%, according to a 2020 study.

In the Ophthalmology Therapy study, investigators in the department of Ophthalmology at Children’s Hospital of Chongqing Medical University in China, wanted to determine the incidence and risk factors for dry eye after pediatric strabismus surgery. Ocular surgery is considered a risk factors for dry eye. Dry eye disease is an inflammatory disease that can lead to dryness, inflammation, pain, discomfort, irritation, diminished quality of life, and in severe cases, permanent vision impairment.

Investigators, led by Yun Wang, observed 48 children who underwent strabismus surgery to evaluate the incidence and risk of postoperative dry eye. The dry eye score system (DESS) questionnaire was used to assess the occurrence of six symptoms of dry eye, including itching, burning, sandy or gritty sensation, redness, blurred vision, ocular fatigue, and excessive blinking.

Investigators found that the incidence of dry eye among the patients in the study was 47.62% at one week after surgery and decreased over time. About 10% of the observed children had dry eye at four weeks and no child had dry eye at eight weeks. They found that tear breakup time, a clinical test used to assess for evaporative dry eye disease, was lower in children who developed dry eye post-surgery.

Among the children in the study, investigators found that the nondominant eyes were more likely to develop postoperative dry eye and girls were more likely to develop dry eye after strabismus surgery. They also found that tear film instability is more common than deficient aqueous tear production in patients with dry eye after surgery.

Investigators noted several limitations, including the fact that they didn’t use the Schirmer’s test, the most common method for evaluating tear production. This test, they said, it is difficult to perform in pediatric patients because of its invasiveness. Investigators also the small sample size may not be generalizable and larger studies are needed.

“In this study, we found that the incidence of dry eye in children after strabismus surgery is high but transient,” they wrote. “A low preoperative BUT (preoperative tear breakup time) is a significant risk factor for postoperative dry eye.”