STODS

Managing Surgical Temporary Ocular Discomfort Syndrome

Maintaining a healthy ocular surface after surgery is critical for achieving optimal visual acuity and patient satisfaction. But this can be challenging given that temporary disturbances to the ocular surface after surgery are common. In fact, Surgical Temporary Ocular Discomfort Syndrome (STODS), a term popularized by the Refractive Surgery Alliance to describe these temporary ocular surface disturbances, is experienced by all patients to varying degrees.[1] The question then is “How can we best mitigate STODS and improve outcomes?” The answer lies in how we assess and manage the ocular surface pre-operatively and how we treat the ocular surface post-operatively.

A pro-active approach is critical for managing and mitigating STODS, especially considering that 80% of patients already have clinically significant ocular surface disease prior to surgery, yet only 22% have a dry eye disease (DED) diagnosis.[1] Combined with the fact that a stable, healthy tear film is necessary for the greatest postoperative vision, it becomes clear that it is especially important to evaluate patients with no symptoms for DED.

When it comes to pre-operative considerations, some are evident when the patient walks in the door. For example, excessive or frequent blinking, skin manifestations of rosacea, blepharitis, incomplete blink, lagophthalmos, or eye rubbing.[1] Subjective observations include contact lens habits, ocular comfort, dry eye symptoms.[1] More clues can be found when observing the ocular surface for anterior blepharitis, meibomian gland dysfunction, punctate corneal staining anterior basement membrane corneal dystrophy or Salzman’s nodules.[1] It’s important to note that many of these are commonly seen in patients with cataracts.

Fundamental to success, both in mitigating STODS and achieving reliable and effective surgical outcomes for patients with a previous diagnosis, it is important to stress the importance of continuing prescription drops leading up to surgery and educating on the impact DED may have on recovery and visual outcomes. For newly diagnosed patients with mild dry eye disease, reasonable first-line treatment options include artificial tears and punctal plugs.

Although to date, there is little written about STODS as a term, it is great to finally have a description for this pervasive post-operative experience for patients. There are treatments currently in development which hold the potential to provide surgeons with additional tools to enhance eye surgery outcomes and improve patient care and satisfaction. 

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