Table 1.

Steps to reduce the risk of cataract surgery-related DED, based on current published literature.

Pre-operative	Intra-operative	Post-operative
Assess for DEDAssess for OSD• Treat pre-existing• DEDMGD	Limit incisional damage• ‘Micro’-incisional surgery• Consider avoiding AKs with DED/OSDLimit drop exposure• Avoid XS topical anaesthetic application• Single pre-op. drop of Povidine 5%• Care with pre-op NSAIDS in those with DED• PF drops in those with DED/OSDLimit repeated drying/irrigation• Consider coating OS with dispersive OVD ○ All those with DED ○ As a routine• Limit surgical time where possibleLimit Phototoxicity• Reduce surgical time/exposure• Microscope illumination ○ Adequate not excessiveLimit surgical trauma• Careful insertion of speculum• Care with FLACS suction ring• Avoid epithelial trauma• Opening FLACS incisions• Limit holding eye with forceps	Assess for DED• Avoid XS drop regimens• Consider PF drops• Lubricating drops/ointment• Management of MGD ○ Lid hygiene ○ Tea tree oil ○ Omega III ○ Topical Azithromicin ○ Systemic tetracycline• Topical Cyclosporin• Other anti-inflammatories ○ Lifitegrast• Mucin Secretagogues• Care with NSAIDs ○ Avoid with DED• Punctal Plugs

DED: dry eye disease; MGD: Meibomian Gland Dysfunction; OSD: Ocular surface disease; NSAIDs: Non-steroidal Anti-inflammatory drugs; FLACS: Femtosecond laser-assisted cataract surgery; OVD: Ophthalmic Viscosurgical Device; XS: Excess; PF: Preservative Free; OS: Ocular Surface.