Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of
dry eye disease (DED), have led to the need for a specific report about iatrogenic
dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as
benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of
contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by
surgical procedures such as corneal
refractive surgery as in
laser-assisted in situ keratomileusis (
LASIK) and
keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs.
Cataract surgery, lid surgeries,
botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early
dry eye prior to surgeries, efforts to establish appropriate
therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.