To evaluate the changes in the clinical signs and symptoms of dry eye syndrome before and after cataract surgery according to the main incision location and the type of artificial tears.

Twenty-four eyes of 17 patients who underwent phacoemulsification and posterior chamber lens insertion from May 2009 to July 2009 were enrolled in the present study prospectively. The main incision location (temporal or superior incision) was determined according to the axis of astigmatism and the postoperative artificial tears (sodium hyaluronate with or without preservatives) were determined randomly. The tear film break-up time (TF-BUT), Schirmer test, esthesiometer, corneal surface grading with Oxford system and ocular surface disease index (OSDI) questionnaire before and 1, 2 and 6 months after surgery were evaluated. The corneal nerve was also analyzed using corneal confocal microscopy (Confoscan 4, Nidek, Italy) before, and 1 and 6 months after surgery.

The TF-BUT was significantly longer ( p = 0.010) and the OSDI score was significantly lower ( p = 0.007) in the patient group with preservative-free sodium hyaluronate than the group with sodium hyaluronate containing preservatives at 6 months after cataract surgery. There were no statistically significant differences according to the main incision location in the sodium hyaluronate without preservatives group.

Symptoms and several signs of dry eye syndrome triggered by cataract surgery decreased with preservative- free artificial tears compared to tears with preservatives.