Dry eye disease is a multifactorial condition of the ocular surface characterized by tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities that can directly compromise the accuracy of cataract surgery planning and the quality of postoperative vision.
This guide covers the nature and prevalence of preoperative dry eye, how it affects surgical measurements and outcomes, diagnostic methods surgeons use to detect it, treatment protocols for stabilizing the ocular surface, risk factors that increase susceptibility, and preparation steps that connect surface health to lens selection.
Research suggests that a large majority of cataract surgery candidates may present with at least one clinical sign of dry eye, often without noticeable symptoms. This means the condition frequently goes undetected unless surgeons actively screen for it during the preoperative workup.
An unstable tear film can distort keratometry readings used in IOL power calculations, potentially leading to refractive surprise. Premium lenses such as multifocal and trifocal IOLs are particularly sensitive to surface irregularities, and unresolved dry eye is associated with higher rates of postoperative dissatisfaction even when visual acuity measures appear normal.
Surgeons rely on structured diagnostic tools, including tear film break-up time, osmolarity testing, inflammatory markers, and meibomian gland imaging, to identify and classify the specific subtype of dry eye present before finalizing a surgical plan.
Treatment typically follows a stepwise approach; artificial tears, prescription anti-inflammatory drops, and in-office thermal pulsation procedures may each play a role depending on disease severity. Clinical guidelines recommend stabilizing the ocular surface for at least 2 to 4 weeks before final biometry is performed, connecting surface treatment directly to accurate lens selection.
What Is Dry Eye Disease and How Does It Affect the Eye?
Dry eye disease is a multifactorial condition of the ocular surface characterized by a loss of tear film homeostasis. The sections below cover its defining pathophysiology, its two primary subtypes, and how a mixed presentation complicates both diagnosis and treatment planning.
What Is the Clinical Definition of Dry Eye Disease?
Dry eye disease is defined by tear film instability, hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities that work together to disrupt normal ocular surface function. According to EyeWiki (American Academy of Ophthalmology), these four mechanisms play direct etiological roles in the condition’s development and progression. Because the disease involves multiple overlapping pathways rather than a single cause, it cannot be reliably managed with a one-size-fits-all approach. For patients preparing for cataract surgery, this complexity makes early identification especially important.
What Are the Two Main Types of Dry Eye Disease?
The two main types of dry eye disease are aqueous tear deficiency (ATD) and evaporative dry eye (EDE). ATD involves insufficient tear production from the lacrimal glands, while EDE is linked to meibomian gland dysfunction and an unstable lipid tear layer. The American Academy of Ophthalmology identifies both as distinct subtypes, each requiring a different diagnostic and treatment focus. Understanding which type is present directly shapes which interventions a surgeon will recommend before surgery.
What Is Mixed-Mechanism Dry Eye and Why Does It Matter?
Mixed-mechanism dry eye is a presentation in which a patient exhibits characteristics of both aqueous-deficient and evaporative dry eye simultaneously. According to the National Institutes of Health (PMC), many patients with dry eye disease present with this combined type, making diagnosis and treatment more complex than either subtype alone. In a preoperative context, this overlap increases the likelihood that a single treatment will be insufficient, and that a layered approach addressing both tear production and lipid layer stability will be necessary.
How Common Is Dry Eye Among Cataract Surgery Candidates?
Dry eye disease is remarkably common among patients preparing for cataract surgery, affecting the majority rather than a small minority. The prevalence figures below explain why surgeons screen for it routinely before any biometry or lens planning begins.
According to the PHACO (Prospective Health Assessment of Cataract Patients’ Ocular Surface) study, up to 80% of patients scheduled for cataract surgery have at least one clinical sign of dry eye disease, although many remain completely asymptomatic. That last point is clinically significant: a patient can have measurable tear film instability without ever reporting a scratchy or burning sensation, meaning self-reported symptoms alone will miss a large portion of affected candidates.
A 2023 systematic review and meta-analysis published on ResearchGate estimated the global pooled prevalence of dry eye disease at 34.6% across the general population. The gap between that general figure and the 80% seen in cataract surgery candidates reflects the demographic reality: cataract surgery patients skew older, and older age is itself a major risk factor for ocular surface dysfunction.
From a clinical planning standpoint, this prevalence means dry eye should be assumed present until ruled out, not the other way around. Treating it as a routine screening step, rather than an incidental finding, is the posture that leads to better surgical outcomes.
Why Can Untreated Dry Eye Compromise Cataract Surgery Results?
Untreated dry eye can compromise cataract surgery results by distorting the measurements needed for accurate lens selection, worsening ocular surface health after surgery, and degrading the quality of vision the procedure is meant to deliver. The subsections below cover how dry eye affects IOL calculations, why symptoms may intensify post-surgery, and how visual quality can suffer.
How Does Dry Eye Affect Preoperative Measurements and IOL Calculations?
Dry eye affects preoperative measurements by introducing instability into the tear film, which distorts the corneal surface that biometry instruments rely on for accurate readings. According to a 2025 review published in PMC (National Institutes of Health), keratometry-related errors due to dry eye disease account for approximately 22% of inaccuracies in IOL power calculations. When keratometry readings are unreliable, surgeons risk selecting the wrong lens power, a scenario known as refractive surprise. This problem is particularly consequential for patients seeking premium IOLs such as multifocal or trifocal lenses, where precision is critical and even small refractive errors can significantly reduce the value of the investment.
How Can Dry Eye Worsen After Cataract Surgery?
Dry eye can worsen after cataract surgery because the surgical incision damages corneal sensory nerves, reducing corneal sensation and disrupting the feedback mechanism that signals the eye to produce tears. According to PMC research, ocular surface dysfunction is a leading cause of patient dissatisfaction after cataract surgery, affecting up to 35% of patients who may otherwise achieve good visual acuity on a Snellen chart. Patients who enter surgery with an already compromised ocular surface face a compounded risk: preexisting inflammation reduces the eye’s ability to recover, and exposure to postoperative eye drop preservatives can further irritate fragile epithelial tissue.
How May Untreated Dry Eye Impact Visual Quality Post-Surgery?
Untreated dry eye may impact visual quality post-surgery by causing an unstable tear film that scatters incoming light before it reaches the lens implant. Even a technically well-performed cataract surgery with a correctly powered IOL cannot fully compensate for an irregular ocular surface. Patients may experience blurred vision, glare, halos, and fluctuating sight that worsens throughout the day as the tear film breaks down. Premium presbyopia-correcting IOLs are especially vulnerable, as their optical design depends on a smooth, consistent tear layer to function as intended.
What Are the Signs You May Have Dry Eye Before Surgery?
The signs you may have dry eye before surgery range from obvious discomfort to no symptoms at all. The following sections cover which symptoms to report to your surgeon and why silent dry eye is a clinically significant concern.
What Symptoms Should You Report to Your Surgeon?
The symptoms you should report to your surgeon include persistent dryness, burning or stinging sensations, intermittent blurred vision, excessive tearing, grittiness, light sensitivity, and eye redness. These symptoms can signal tear film instability that may affect surgical measurements and outcomes.
Reporting these symptoms before your consultation is important because dry eye disease is a multifactorial condition involving tear film instability, ocular surface inflammation, and neurosensory abnormalities, according to EyeWiki (American Academy of Ophthalmology). Any of these factors can influence the accuracy of preoperative testing. Even mild, occasional symptoms deserve mention, as they may point to an underlying condition that requires treatment before surgery proceeds.
Can You Have Dry Eye Without Noticeable Symptoms?
Yes, you can have dry eye without noticeable symptoms. The PHACO study (Prospective Health Assessment of Cataract Patients’ Ocular Surface), published in PMC, found that up to 80% of patients scheduled for cataract surgery have at least one clinical sign of dry eye disease, although many are asymptomatic.
This means a significant portion of cataract candidates carry measurable ocular surface disease without feeling discomfort. Silent dry eye can still compromise keratometry readings and IOL power calculations. Routine preoperative screening, rather than symptom reporting alone, is the only reliable way to detect it.
How Do Surgeons Diagnose Dry Eye Before Cataract Surgery?
Surgeons diagnose dry eye before cataract surgery using a structured set of clinical tests that assess tear film stability, corneal surface integrity, and meibomian gland function. The sections below cover the key diagnostic tools used in each area of evaluation.
What Tests Are Used to Evaluate Tear Film Stability?
The tests used to evaluate tear film stability include tear film break-up time (TBUT), tear osmolarity measurement, corneal staining, and inflammatory marker testing such as MMP-9.
Dry eye disease is a multifactorial condition involving tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities, according to EyeWiki (American Academy of Ophthalmology). The two primary subtypes are aqueous tear deficiency (ATD), caused by reduced lacrimal gland output, and evaporative dry eye (EDE), driven by meibomian gland dysfunction.
Each test targets a different dimension of the condition:
- TBUT measures how quickly the tear film breaks down between blinks.
- Tear osmolarity detects hyperosmolarity and, according to a study published in the Cornea Journal, tends to identify dry eye disease earlier than corneal staining, which is typically a late-stage finding.
- Corneal and conjunctival staining reveals surface damage but may only appear once disease has progressed.
- MMP-9 testing flags active ocular surface inflammation.
Shortened TBUT is particularly critical because, according to research published in PMC, it negatively impacts keratometry reliability and IOL power calculation accuracy. In practice, no single test is sufficient; surgeons who rely on one diagnostic measure alone risk missing clinically significant disease.
What Role Does Corneal Surface Imaging Play in Detection?
Corneal surface imaging plays a role in detection by revealing irregular surface topography and epithelial changes that clinical examination alone may not capture.
Topography and tomography maps display irregularities in corneal curvature caused by an unstable tear film, which can mimic or mask underlying corneal pathology. This distinction matters directly for IOL selection, as an unstable ocular surface produces unreliable keratometry readings.
A contributing factor that imaging can help identify is chemical epithelial damage. Benzalkonium chloride (BAK), the most widely used preservative in topical eye drops, has been associated with toxic effects on corneal and conjunctival epithelial cells, according to a PMC study, potentially worsening surface irregularity in patients on long-term topical therapy. Imaging provides a visual baseline that helps surgeons track surface changes before and after preoperative dry eye treatment.
How Do Meibomian Gland Assessments Factor Into Diagnosis?
Meibomian gland assessments factor into diagnosis by identifying evaporative dry eye, the most common subtype seen in cataract surgery candidates, before it disrupts biometric measurements.
Meibography uses infrared imaging to visualize gland structure and detect dropout or truncation, while manual expression evaluates the quality and quantity of meibum secretion. Lid margin examination checks for signs of blepharitis, plugging, or vascular engorgement that indicate chronic gland obstruction.
Because evaporative dry eye is frequently asymptomatic, meibomian gland evaluation is one of the most important steps in uncovering disease that patients themselves may not report. Identifying gland dysfunction early allows surgeons to incorporate targeted treatments into the preoperative plan before finalizing IOL calculations.
What Are the Types of Dry Eye That Affect Surgical Planning?
The types of dry eye that affect surgical planning are aqueous-deficient dry eye, evaporative dry eye, and mixed-mechanism dry eye. Each subtype has distinct causes and requires a different treatment approach before cataract surgery proceeds.
Aqueous-Deficient Dry Eye
Aqueous-deficient dry eye is a subtype characterized by insufficient tear production from the lacrimal glands. According to the American Academy of Ophthalmology, this form of dry eye disease (aqueous tear deficiency) results from lacrimal gland failure, producing a chronically low tear volume that leaves the ocular surface exposed and unstable. Because preoperative biometry depends on a consistent, smooth tear film, low tear volume may distort keratometry readings and compromise IOL power calculations before surgery can safely proceed.
Evaporative Dry Eye
Evaporative dry eye is driven by meibomian gland dysfunction, which causes the lipid layer of the tear film to break down too rapidly. Even when tear volume is adequate, an unstable lipid layer allows tears to evaporate faster than normal, shortening tear film break-up time. This instability is particularly disruptive to topographic and biometric measurements used in surgical planning, making meibomian gland assessment a routine step in any cataract surgery workup.
Mixed-Mechanism Dry Eye
Mixed-mechanism dry eye is a subtype that combines characteristics of both aqueous deficiency and evaporative dysfunction. A review published in PMC (National Institutes of Health) notes that many patients present with this combined form, which can make diagnosis and targeted treatment considerably more complex. Surgeons should anticipate that mixed-mechanism dry eye may require a layered treatment strategy before biometry results can be considered reliable.
How Is Dry Eye Treated Before Cataract Surgery?
Dry eye treatment before cataract surgery follows a stepwise approach, progressing from basic lubrication to prescription therapy and in-office procedures. The sections below cover artificial tears, anti-inflammatory drops, meibomian gland treatments, and recommended treatment timelines.
How May Artificial Tears and Lubricants Help Stabilize the Surface?
Artificial tears and lubricants may help stabilize the ocular surface by supplementing the natural tear film and reducing friction between the eyelid and cornea. Preservative-free formulations are generally preferred before surgery, as repeated exposure to preservatives such as benzalkonium chloride can irritate the surface rather than soothe it. Frequent use throughout the day can temporarily restore tear volume, smooth corneal irregularities, and improve the quality of preoperative measurements. While lubricants alone may be insufficient for moderate-to-severe dry eye, they remain a foundational first step in nearly every preoperative optimization plan.
How Do Prescription Anti-Inflammatory Drops Reduce Dry Eye?
Prescription anti-inflammatory drops reduce dry eye by targeting the underlying inflammatory cycle that disrupts tear production and ocular surface integrity. Two widely used options are cyclosporine A (Restasis) and lifitegrast (Xiidra). According to data from Greenwich Eye, lifitegrast may show symptomatic improvement as early as week 2 in some patients, while cyclosporine A typically requires 3 to 6 months to produce a meaningful increase in tear production. Because of this difference in onset, the choice of medication is an important factor in surgical planning, particularly when the surgical timeline is fixed.
How Does Meibomian Gland Expression or Thermal Treatment Help?
Meibomian gland expression and thermal treatment help by restoring lipid secretion to the tear film, addressing evaporative dry eye at its source. Thermal pulsation systems like LipiFlow have been shown to improve meibomian gland function, with measurable gains in tear film break-up time (TBUT) and meibomian gland yield secretion score (MGYSS), according to a study published in PMC. Notably, research published in the European Journal of Ophthalmology found that LipiFlow treatment administered as early as one day before cataract surgery can improve postoperative tear film stability. For patients with confirmed meibomian gland dysfunction, in-office thermal treatment is one of the most targeted and time-efficient preoperative interventions available.
How Long Before Surgery Should Dry Eye Treatment Begin?
Dry eye treatment should begin early enough to allow the ocular surface to stabilize before final surgical measurements are taken. The ASCRS Cornea Clinical Committee recommends treating visually significant ocular surface disease until the surface is stable, typically requiring at least 2 to 4 weeks of treatment before final biometry and IOL power calculations are performed, according to a guideline published in the Journal of Cataract and Refractive Surgery. Starting treatment well in advance of the surgical date gives the cornea time to recover, reduces measurement variability, and supports more accurate IOL selection.
What Happens If Dry Eye Is Not Addressed Before Surgery?
Leaving dry eye untreated before cataract surgery can compromise measurement accuracy, wound healing, and final visual outcomes. The subsections below address IOL power errors, healing risks, and premium lens dissatisfaction.
How May Inaccurate IOL Power Selection Affect Vision?
Inaccurate IOL power selection may result from dry eye disease distorting the corneal surface data used in preoperative biometry. An unstable tear film causes irregularities in keratometry readings, producing unreliable curvature measurements. When these flawed inputs feed IOL power formulas, the calculated lens power may be off, leaving the patient with unintended residual refractive error after surgery. According to a study published in PMC (National Institutes of Health), keratometry-related measurement errors due to dry eye disease account for approximately 22% of inaccuracies in IOL power calculations. In practical terms, this means a patient could leave surgery needing glasses for distance or near vision that an accurate preoperative measurement may have prevented. Optimizing the ocular surface before biometry is, in many clinicians’ views, among the highest-yield steps available to reduce refractive surprise.
What Are the Potential Risks of Poor Wound Healing?
The potential risks of poor wound healing include delayed epithelial recovery, persistent ocular surface inflammation, and increased susceptibility to postoperative infection. An already compromised ocular surface, characteristic of untreated dry eye, lacks the stable tear film and sufficient mucin layer needed to support normal corneal epithelial repair after a surgical incision. Reduced corneal sensation from the incision further disrupts the feedback loop that stimulates tear production, compounding surface damage in the early postoperative period. Poor wound healing can extend recovery time and heighten patient discomfort, reducing overall surgical satisfaction even when the IOL itself is well positioned.
How Could Untreated Dry Eye Lead to Dissatisfaction with Premium IOLs?
Untreated dry eye could lead to dissatisfaction with premium IOLs because tear film instability directly degrades the optical performance these lenses depend on. Multifocal and trifocal lenses are particularly sensitive to ocular surface irregularities; even mild tear film disruption can scatter incoming light and reduce contrast sensitivity. According to Dr. Sumit “Sam” Garg, Vice Chair of Clinical Ophthalmology at the Gavin Herbert Eye Institute, “One study found that the main reason for dissatisfaction after implantation of diffractive IOLs was DED. It is important, therefore, to discuss this potential in DED patients who request these lenses.” Residual refractive error and dry eye are identified as the most common causes of dissatisfaction among presbyopia-correcting IOL recipients. Patients investing in premium lenses carry correspondingly high visual expectations, making preoperative surface optimization not just a clinical priority but a patient-experience one.
Who Is Most at Risk for Dry Eye Before Cataract Surgery?
Certain patient profiles carry a measurably higher risk of preoperative dry eye disease. The sections below cover three key risk groups: older adults, long-term eye drop users, and contact lens wearers.
Are Older Adults More Susceptible to Preoperative Dry Eye?
Older adults are more susceptible to preoperative dry eye because the incidence of both cataract and dry eye disease increases with advancing age. According to a review published in Ophthalmology and Therapy, older age is a significant risk factor for the coexistence of cataract and dry eye disease, meaning the two conditions frequently occur together in the same patients. Age-related changes in lacrimal gland function, meibomian gland health, and eyelid anatomy all contribute to this overlap. In practice, surgeons evaluating older patients should treat dry eye screening as a routine step rather than an occasional one.
Does Long-Term Use of Eye Drops Increase Dry Eye Risk?
Long-term use of eye drops, particularly those containing the preservative benzalkonium chloride (BAK), can increase dry eye risk by damaging the ocular surface over time. Patients who have used glaucoma medications chronically are especially vulnerable, as repeated preservative exposure may compromise the corneal and conjunctival epithelium. Identifying this history early in the surgical workup allows the care team to transition patients to preservative-free formulations before biometry and intraocular lens power calculations are performed.
Are Contact Lens Wearers at Higher Risk?
Contact lens wearers are at higher risk for dry eye disease before cataract surgery. According to a study published in PLOS ONE, contact lens wear and a history of glaucoma medication use are both identified risk factors that contribute to the development and severity of dry eye syndrome. Prolonged lens wear can disrupt the tear film, reduce corneal sensitivity, and accelerate meibomian gland changes. Surgeons typically advise a contact lens holiday prior to the preoperative evaluation to allow the ocular surface to stabilize before measurements are taken.
What Should You Expect During the Preoperative Dry Eye Workup?
The preoperative dry eye workup is a structured evaluation your surgeon performs to assess ocular surface health before finalizing your cataract surgery plan. It typically involves a combination of symptom review, diagnostic testing, and tear film analysis to identify and grade any dry eye disease present.
During the workup, your surgeon or a trained technician may conduct several assessments, including:
- Symptom questionnaire: Standardized tools, such as the SPEED or OSDI questionnaire, help quantify your reported discomfort, burning, tearing, and visual fluctuation.
- Tear film break-up time (TBUT): A dye is placed on the eye’s surface to measure how quickly the tear film destabilizes, which directly affects keratometry reliability.
- Tear osmolarity testing: This measures salt concentration in the tear film and can serve as an earlier indicator of dry eye disease than corneal staining alone, according to a study published in the journal Cornea.
- MMP-9 testing: A rapid point-of-care test detects inflammatory markers on the ocular surface, helping identify patients with significant inflammation.
- Meibomian gland evaluation: The surgeon examines gland structure and expressibility to detect evaporative dry eye.
- Corneal and conjunctival staining: Fluorescein or lissamine green dyes reveal surface damage that may indicate more advanced disease.
The ASCRS Preoperative OSD Algorithm also recommends that patients discontinue contact lens wear for at least two weeks and avoid using eye drops within two to four hours before the visit, so measurements reflect the true baseline ocular surface state.
Based on these findings, your surgeon will determine whether dry eye must be treated before biometry measurements and IOL power calculations are finalized. For most patients, this evaluation is completed during a dedicated preoperative visit, though additional follow-up may be scheduled if active disease is detected.
How Can You Prepare for Cataract Surgery If You Have Dry Eye?
Preparing for cataract surgery with dry eye involves completing a structured preoperative workup, following a treatment plan to stabilize the ocular surface, and communicating openly with your surgical team. The steps below cover what to expect and how to get ready.
Start Treatment Early
Preparing well means beginning dry eye treatment as early as possible before your scheduled procedure. The ASCRS Cornea Clinical Committee recommends that visually significant ocular surface disease be treated until the ocular surface is stable, typically requiring at least 2 to 4 weeks of treatment before final biometry and IOL power calculations are performed. Rushing this timeline risks inaccurate measurements and a poor refractive outcome. Starting treatment promptly gives your surgeon the most reliable data for selecting your lens.
Follow Your Surgeon’s Pre-Visit Instructions
Your surgeon’s pre-visit instructions are an essential part of the preparation process. The ASCRS Preoperative OSD Algorithm recommends a 2-week contact lens holiday and no eye drops within 2 to 4 hours of your preoperative visit. Both steps allow the ocular surface to reflect its true baseline condition, ensuring that diagnostic readings are not artificially altered by lens wear or recent drop use.
Disclose All Medications and Eye Drops
Disclosing all current medications and eye drops to your surgeon is critical before cataract surgery. Preservatives such as benzalkonium chloride (BAK), found in many topical eye drops, can damage corneal and conjunctival epithelial cells and worsen dry eye. Knowing exactly what you use allows your care team to substitute preservative-free alternatives or adjust your regimen before surgery, reducing the risk of surface irritation that could compromise your outcome.
Attend All Scheduled Diagnostic Appointments
Attending every preoperative diagnostic appointment prepares you for cataract surgery by ensuring your surgical team has accurate, stable measurements. These visits allow your surgeon to monitor your tear film break-up time, osmolarity, and corneal surface health as treatment progresses. Skipping or delaying these appointments can result in IOL calculations based on an unstable ocular surface, which may lead to residual refractive error after surgery.
Ask About Your IOL Options Given Your Dry Eye Status
Your IOL options given your dry eye status are an important conversation to have before your surgery date. Premium lenses such as multifocal and trifocal IOLs are particularly sensitive to tear film instability, and unresolved dry eye can degrade visual quality even after a technically successful procedure. Discussing your lens options with your surgeon once your surface is stable helps ensure the chosen IOL matches both your vision goals and your ocular surface health, reducing the risk of dissatisfaction.
How Does Treating Dry Eye Connect to Choosing the Right Lens and Surgical Plan?
Treating dry eye connects directly to lens selection and surgical planning because an unstable ocular surface distorts the measurements surgeons rely on to choose the right IOL. The H3s below explain how Eye Surgery Today’s resources support your preparation and what the most important takeaways are for managing dry eye before surgery.
Can Eye Surgery Today’s Cataract Surgery Resources Help You Prepare?
Yes, Eye Surgery Today’s cataract surgery resources can help you prepare by translating clinical evidence into clear, actionable guidance for patients navigating dry eye before surgery. The PHACO study found that up to 80% of cataract surgery candidates show at least one clinical sign of dry eye disease, with many unaware of it. Research published in the Journal of Cataract & Refractive Surgery identifies corneal sensory nerve damage from the surgical incision as a primary mechanism driving post-surgical dry eye, disrupting the feedback loop that sustains normal tear production. Understanding these risks before your consultation helps you ask better questions and engage more effectively with your surgical team. Eye Surgery Today’s surgeon-reviewed educational guides cover IOL options, biometric accuracy, and ocular surface preparation, giving patients a strong foundation for those conversations.
What Are the Key Takeaways About Treating Dry Eye Before Cataract Surgery?
The key takeaways about treating dry eye before cataract surgery are that early diagnosis, structured preoperative treatment, and stable ocular surface conditions are essential for accurate IOL selection and satisfying outcomes. According to Dr. Christopher Starr, Associate Professor of Ophthalmology at Weill Cornell Medicine, the ASCRS Cornea Clinical Committee developed a consensus-based diagnostic algorithm specifically to identify and treat visually significant ocular surface disease before any refractive surgery is performed. The ASCRS Preoperative OSD Algorithm begins with a 2-week contact lens holiday and restricts eye drop use within 2 to 4 hours of the preoperative visit to ensure reliable baseline measurements. Taken together, the evidence makes one clinical priority clear: ocular surface stability is not a secondary concern but a prerequisite for a successful surgical plan.
