Surface Ophthalmics

When it comes to managing and mitigating Surgical Temporary Ocular Discomfort Syndrome (STODS), a natural question is, “Can you predict who will get STODS?” The answer is nuanced.

Nearly all patients who undergo ocular surgery will experience some degree of STODS, but what separates mild symptoms from debilitating ones? If unaddressed dry eye is present prior to surgery, this may have a significant influence on the severity of STODS symptoms that patients experience.

It is estimated that up to 80% of preoperative surgical patients have evidence of dry eye, yet only 22% have a previous diagnosis. [i] Therefore, a comprehensive evaluation of the ocular surface is essential to diagnosing existing dry eye.

Evaluating the Ocular Surface Before Surgery

A proactive approach to diagnosing dry eye is important for several reasons. In addition to managing and mitigating STODS, dry eye may change the surgical treatment plan and influence measurements needed for successful refractive correction. A comprehensive ocular surface evaluation is important for all patients but particularly for those undergoing cataract or refractive correction surgeries.

When it comes to evaluating a patient for dry eye, some signs may be apparent when the patient first walks into the room; excessive or rapid blinking, eye rubbing, or symptoms of blepharitis are easy to spot. Other indications, however, require a closer examination, for example:

  • Patient history – contact lens wear, ocular comfort, underlying medical conditions, symptoms of dry eye or blepharitis
  • Tear film evaluation – rapid tear break up time, tear lake depth
  • Corneal health – punctate epithelial erosions, Salzmann’s nodules
  • Eyelid evaluation – meibomian gland health, eyelid closure

A preemptive dry eye evaluation is the first step in preparing the ocular surface for surgery.

Optimizing the Ocular Surface Preoperatively

It’s critical to optimize the ocular surface before surgery, and if dry eye is present, this means ensuring a stable tear film. The first-line treatment for mild dry eye is artificial tears. This generally results in about a 25% improvement of symptoms. [i]  Punctal plugs may also be beneficial in some patients. Patient counseling as to the importance of an optimized ocular surface prior to surgery is also key. When patients understand that dry eye can affect measurements that determine surgical outcomes, as well as increase the risk of STODS symptoms post-surgery, the more likely they are to use drops as directed.

Early diagnosis and intervention are key to managing dry eye symptoms, mitigating STODS, and ensuring a successful surgical outcome. In our next post, we will delve into post-surgical management of STODS to promote healing and minimize discomfort.


[i] Hirabayashi M., Barnett, B. Solving STODS – Surgical Temporary Ocular Surface Discomfort Syndrome. Diagnostics 2023, 13, 837.)