Surface Ophthalmics


STODS – Understanding Post-Surgical Ocular Discomfort 


Optimal patient outcomes following ocular surgery is every surgeon’s goal. And when it comes to refractive and cataract surgeries, the focus is often improved visual acuity. Of course, taking a holistic view of all potential complications is also important, and this includes addressing post-operative ocular surface perturbations. This is one of the reasons the Refractive Surgery Alliance (RSA) coined the term Surgically Induced Temporary Ocular Discomfort Syndrome or STODS.

While STODS is not a new condition, having standardized terminology to describe what nearly all ocular surgical patients experience to some degree is. The more we understand about STODS and are able to discuss it using a common framework, the better we can become at achieving the common goal of improving post-surgical patient satisfaction.


What causes STODS?

STODS is caused by the disruption of the ocular surface homeostasis following ocular surgery.

Ocular surgery disrupts the complex and delicate ecosystem of the ocular surface – the balance between tear production, tear film stability, and the health of corneal epithelium and eyelid margins.

Surgery, by its very nature, can trigger an inflammatory response as a necessary part of the healing process. But this can lead to temporary changes in tear film composition, tear quality and overall ocular surface integrity. A range of uncomfortable symptoms can occur, such as:

  • Grittiness
  • Itchiness
  • A burning sensation
  • Intermittent sharp pain

While these symptoms are similar to those of dry eye disease (DED), and DED can be exacerbated by surgery, STODS is distinct in that it is temporary in nature, typically resolving in a few days to a few months.


Why is it important to recognize STODS?

The RSA recognizing the need for a dedicated term for this post-surgical experience is important for several reasons:

Patient Validation: Giving it a name validates the discomfort patients experience.

Improved Communication: STODS gives a clear way for surgeons and patients to discuss these temporary disruptions that occur post-surgery.

Standardized Care: A defined term offers a foundation for standardizing strategies for mitigation and post-operative care.


The term STODS sheds light on a common postoperative condition. Formally recognizing this temporary disruption in ocular surface homeostasis and the resulting discomfort it can cause is the first step towards implementing appropriate management strategies.