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Abstract

Background and Aim: Dry Eye syndrome is a recognized postoperative complication after cataract surgery, which can affect the visual comfort and recovery of patients. Both extra-capsular cataract extractions (ECCE) and phacoemulsification are standard surgical approaches for removing cataracts, but their comparative impact on tear film stability remains under investigation. To determine the frequency of the occurrence of dry eye after extra-capsular cataract extractions (ECCE) vs. phacoemulsification in patients undergoing cataract surgery. Patients and Methods: Study Design: Randomized controlled trial. Study Setting: The trial was conducted at Eye Unit III, Institute of Ophthalmology, Mayo Hospital Lahore, from November 01, 2024 to April 30, 2025. 60 cases of cataract (aged 40–70 years) with NS+2 and NS+3 cataracts were enrolled using non-probability purposive sampling. Patients equally divided into two groups: ECCE (n=30) and Phacoemulsification (n=30). Pre-existing dry eye, Meibomian gland dysfunction, prior ocular surgeries, or medication-related risk factors for dry eye excluded. Dry Eye was assessed using the Schirmer I Test (ST-I) and TEAR Breakup time (TBUT) and 1, 4, and 12 weeks later postoperative. The dry eye was defined as St-I <10 mm and TBUT <10 seconds on three consecutive readings. Data was analyzed using the SPSS V21, and the importance was determined at P <0.05. Results: The overall mean age was 58.7 ± 6.2 years. Out of 60 cases, 31 (51.7%) were male and 29 (48.3%) female. The frequency of dry eye occurrence was significantly higher in patients undergoing Extra-Capsular Cataract Extraction 60% (n=18) compared to those undergoing Phacoemulsification 26.7% (n=8) at 12 weeks postoperatively. The Schirmer I Test and Tear Break-Up Time values in both groups ECCE vs. Phacoemulsification were 8.2 ± 2.1 mm vs. 9.4 ± 1.8 mm and 7.5 ± 1.3 s vs. 8.6 ± 1.1 after 1 week, which increased to 9.5 ± 1.9 mm vs. 11.0 ± 1.5 mm and 8.1 ± 1.2 s vs. 9.5 ± 1.1 s, after 12 weeks respectively. These findings indicate that both values are consistently lower in the ECCE group across all time intervals, indicating poorer tear film stability and aqueous production. Conclusion: The frequency of dry eye occurrence was significantly higher in patients undergoing Extra-Capsular Cataract Extraction compared to those undergoing Phacoemulsification at 12 weeks postoperatively. Both Schirmer I Test and TBUT results indicated a statistically significant reduction in tear production and stability in the Extra-capsular group compared to the Phacoemulsification group.