Objective:

To compare the impact of manual small incision cataract surgery (MSICS) and phacoemulsification on dry eye disease (DED) postoperatively.

Key Findings:

• Both surgical techniques resulted in acute deterioration of ocular surface health, most notably on post-op Day 1.
• OSDI scores increased, while Schirmer I and tear breakup time (TBUT) decreased across both groups, with gradual improvement by Day 60.
• Recovery was incomplete by Day 60, with OSDI and Schirmer I remaining significantly worse than baseline.
• TBUT was significantly lower in the MSICS group at all postoperative visits, indicating greater tear film instability.
• Meibomian gland dysfunction improved postoperatively but showed worse meibum quality in the phacoemulsification group by Day 60.

Interpretation:

DED is a significant postoperative issue following cataract surgery, with MSICS leading to greater tear film instability and phacoemulsification associated with persistent meibomian gland disturbance.

Limitations:

• The study was limited to a single center and a relatively small sample size.
• Long-term effects beyond 60 days were not assessed.

Conclusion:

DED should be recognized as a predictable postoperative event, and routine screening tools should be integrated into perioperative care for better management.