|Year : 2017 | Volume
| Issue : 1 | Page : 65-66
Lid conditions affecting cataract surgery
Oculoplasty and Squint Service, Axis Eye Clinic, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
|Date of Submission||03-Aug-2016|
|Date of Acceptance||03-Nov-2016|
|Date of Web Publication||6-Dec-2016|
Axis Eye Clinic, Kumar Millenium, Shivtirth Nagar, Near Rohan Corner, Paud Road, Kothrud, Pune - 411 038, Maharashtra
Source of Support: None, Conflict of Interest: None
Postcataract surgery endophthalmitis remains the greatest nightmare for the cataract surgeon. Most of the reported cases have found that the ocular adnexa are the major contributor of microorganisms. Conditions such as blepharitis, chalazion, stye, and entropion have a higher load of microorganisms and can be responsible for infection. It is important to manage these conditions before performing cataract surgery.
Keywords: Blepharitis, canaliculitis, chalazion, endophthalmitis
|How to cite this article:|
Murthy R. Lid conditions affecting cataract surgery. J Clin Ophthalmol Res 2017;5:65-6
The lids are exposed to the outer world and harbor numerous microorganisms. Lid hygiene is imperative before cataract surgery is undertaken as there is a serious risk of infection if any lid infection or abnormalities are neglected. Thorough examination of the lids is essential before performing cataract surgery. This article highlights the importance of lid conditions which are often overlooked before cataract surgery.
There are many lid conditions which have a direct influence on cataract surgery and may affect the outcome negatively if not treated. Among these, the most prominent are blepharitis, entropion, trichiasis, chalazion, stye, and ocular surface diseases such as cicatricial pemphigoid which can cause lid margin disease. When we look at the adnexa, we must not forget conditions such as canaliculitis and dacryocystitis which can create great risk and poor outcome for cataract surgery.
In acute postoperative endophthalmitis, the role of external bacterial flora has been identified. Adnexal tissues have been implicated as the source of infection in many cases and of major concern is the fact that organisms in the vitreous tap and lid margin are identical in nearly 82% of the cases. 
Blepharitis remains the most important cause of postponement of surgery. Nearly 60% of the elderly patients have blepharitis, and this is a significant comorbid condition. The anterior form could be squamous with greasy scales and dandruff-like material at the base of the lashes or the staphylococcal form with hard brittle scales and bleeding on the removal of the crusts. Posterior blepharitis is characterized by oil globules capping the meibomian gland orifices and a foamy tear film.  The organisms commonly implicated in anterior blepharitis include Staphylococcus epidermidis, Propionibacterium acnes, Corynebacterium, and Demodex folliculorum.  The presence of Rosacea and atopic dermatitis increases the Staphylococcus aureus numbers in lid and conjunctival cultures. Rosacea also increases the cell-mediated immunity to Staphylococcus aureus.
The issues faced by the patient due to blepharitis are irritated eyes, longer duration of inflammation, poorer visual acuity on the first postoperative day, and risk of postoperative endophthalmitis. Patients may develop dry eyes, lid margin problems, punctate keratitis, and even corneal ulceration. An interesting study on the cancellation rates for cataract surgery due to blepharitis mentioned that the rates of cancellation were most commonly due to blepharitis, and there was a significant decrease in cancellation rates once the patients were counseled about lid hygiene.  The treatment of blepharitis includes lid and face hygiene, artificial tears to alleviate the dry eyes, antibiotic or antibiotic steroid ointment, and oral doxycycline 100 mg daily in recalcitrant cases.
Chalazion is a chronic, sterile, granulomatous inflammatory lesion of the lids. When it is secondarily infected, it is referred to as an internal hordeolum. While most of these resolve spontaneously, surgery in the form of incision and curettage, steroid injection, or systemic tetracycline is needed in some cases. External hordeolum or stye is an acute staphylococcal infection of a lash follicle. Topical antibiotics are needed with hot compresses and epilation of the associated lash. While there is no literature on whether cataract surgery should be deferred in the presence of chalazion, it is prudent to wait till complete resolution of the chalazion before embarking on cataract surgery. Once the stye has resolved, it is best to perform conjunctival cultures and perform cataract surgery with preoperative topical antibiotics.
In the presence of conditions such as ocular cicatricial pemphigoid where there is associated lid margin disease, it is best to make the disease quiescent and control all conjunctival inflammations before performing cataract surgery. Once quiet, one should perform conjunctival cultures 2 weeks before the surgery and start the patient on topical antibiotics for at least 7 days before surgery. 
Entropion and trichiasis need to be managed before embarking on cataract surgery as lashes and lids rubbing on the ocular surface carry potential risks of infection. Interestingly, there have been innovations such as the Li-drape which is a circular drape put on a speculum and reduces the bacterial contamination rates.  Another study by Ye et al. was on the role of lid compression in increasing microbial contamination. Lids scrubbed repeatedly with a sterile applicator after sterilization with betadine had a greater positive lid margin culture of 23.53% versus only 9.8% positive bacterial cultures after sterilization alone was performed. 
There are no clear-cut guidelines about the time interval before performing cataract surgery when these lid conditions are present. Suggested guidelines are: in blepharitis - wait for 21 days after starting treatment, perform bacterial cultures from the conjunctiva, and start preoperative antibiotics. In cases of stye and chalazion, wait for at least 7 days until complete resolution, perform conjunctival cultures, and start preoperative antibiotics topically. In entropion and trichiasis, it is prudent to wait for 2 weeks after surgery before performing cataract surgery.
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Conflicts of interest
There are no conflicts of interest.
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