CLINICAL ASPECTS AMT, vol II, nr. 2, 2010, pag. 178 OCULAR SURFACE PATHOLOGY IN EYE SURGERY KARIN HORVATH 1 , FLORINA VULTUR 2 1,2 Ophthalmology Clinic, Târgu-Mureş Keywords: OSD, eye surgery Abstract: Ocular surface disorder such as „dry eye” significantly affects subjective and objective postoperative results, especially in anterior segment surgeries. Preoperative recognition of ocular surface pathology, along with an eyelid-meibomian co-affection and appropriate preoperative preparation of the ocular surface remain essential conditions for successful surgery. It discusses the factors that determine the setting of ocular surface diseases, its pathophysiological mechanisms, diagnostic methods and therapeutic approaches. Cuvinte cheie: OSD, chirurgie oculară Rezumat: Patologia suprafeţei oculare de tip „ochi uscat” influenţează semnificativ, obiectiv şi subiectiv, rezultatele postoperatorii în intervenţiile chirurgicale în special de pol anterior. Recunoaşterea preoperatorie a unei patologii de suprafaţă oculară, alături de o coafectare palpebrală- meibomiană, cu iniţierea unei pregătiri preoperatorii adecvate a suprafeţei oculare constituie o condiţie esenţială a reuşitei chirurgicale. Se discută factorii ce determină instalarea unei patologii de suprafaţă oculară, mecanismele sale fiziopatologice, metodele de diagnostic precum şi abordările terapeutice. 1 Corresponding Author: Karin Horvath, Oftalmology Târgu-Mureş, 26 Marton Aron street, 540082 Târgu-Mureş, România, e-mail: kuhorvath@gmail.com, tel +40- (0265) 26.21.22 Article received on 01.02.2010 and accepted for publication on 8.02.2010 ACTA MEDICA TRANSILVANICA June 2010; 2(2)178-180 INTRODUCTION The term ocular surface disease (OSD) was first used by John Dart to describe a group of disorders of diverse pathogenesis in which disease results in failure of mechanisms that maintain a healthy ocular surface. Dry eye or Ocular Surface Syndrome (OSS) is a term which is now used to describe a variety of conditions, sharing common symptoms and clinical signs, leading to a physical and functional break-down of the tear film. Etiology of dry eye may be divided into 2 entities: 1. Lacrimal deficiency 2. Excessive evaporation of unstable lacrimal film Lacrimal deficiency on the sidelines include Sjögren's syndrome and other syndromes (also called non-Sjögren) such as congenital and or acquired lacrimal deficiency in some diseases such as sarcoidosis, HIV, xerophthalmia, lacrimal obstruction in trachoma, pemphigus, after burns injuries, respectively insufficient lacrimal secretion due to nerve blocking in neuroparalitic keratopaty and in contact lens wearers. Excessive evaporation due to insufficient lipid layer of the tear film is present in eyelid meibomian glands dysfunction, anterior or posterior blepharitis. Also anatomical deficits, the shape and position of the eyelids or palpebral fissure, respectively functional deficits may expose the ocular surface to evaporation. Holland and Mannis in 2002 defined the OSD as an imbalance that occurs in complex interrelation between the 3 major elements: lacrimal film (with its 3 components), blink as a reflex phenomenon influencing the distribution of tears on ocular surface being itself activated by tear evaporation, and tearing witch provides an aqueous component to lacrimal film, the result of trigeminal stimulation by various external factors such as pollutants, allergens. The complains of the patients generally lead to a plausible etiology. Itching is specific in allergic phenomenon, burning sensation guide us to dry eye pathology. It seems that in our everyday practice OSS is incredibly underdiagnosed (1) Everyone knows the typology of the patient, usually women who claim to suffer from constant and repetitive eye stinging, tearing, or even describe the sensation of dry eye. Consultation is completed in the best case prescribing a particular type of artificial tears, which often is changed due to unsatisfactory results found by the patient. OSS recognition is even more important as the patient is to undergo surgery such as refractive surgery or cataract surgery. The true refractive surface of the eye is the tear film, therefore the quality of vision depends on a healthy ocular surface. Attention should be given for preoperative identification of high risk patients: - patients with a history of diagnosed dry eye - patients with intolerance to contact lenses presented for refractive surgery, intolerance itself constitutes a sign of OSD - patients with hormonal disorders, androgen deficiency (which is associated with lacrimal glands and meibomian glands dysfunction), diabetics, people with rheumatic diseases - abnormalities of the eyelid, conjunctiva, cornea, local trauma history - older patient, menopause - systemic medications: alpha, beta blockers, antiaritmia, antidepresives, antiparkinson, antihistamines, others (marijuana). Preoperative evaluation must be more comprehensive as the patient falls from anamnesis in high-risk group. The evaluation starts with thorough visual inspection of the ocular