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Provide ‘biological cleansing’ before ocular surgery
Дата публикации: 20-07-2026 18:40:22
Before ocular surgery, subtle inflammation on the eye’s surface should be controlled with lubricating eye drops, eyelid wipes, diet changes and other methods as necessary, according to a review.This process of “biological cleansing” may help lower the risk for surgical complications, including pain, irritation, ectasia, corneal haze and dry eye disease, Rohit Shetty, DNB, FRCS, PhD, of the department of cornea and refractive surgery at Narayana Nethralaya, India, and colleagues wrote in Indian Journal of Ophthalmology.“A growing body of evidence points to preexisting ocular surface
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- Subclinical inflammation is linked to surgical complications, including pain and dry eye.
- The biological cleansing framework targets control of different levels of inflammation.
Before ocular surgery, subtle inflammation on the eye’s surface should be controlled with lubricating eye drops, eyelid wipes, diet changes and other methods as necessary, according to a review.
This process of “biological cleansing” may help lower the risk for surgical complications, including pain, irritation, ectasia, corneal haze and dry eye disease, Rohit Shetty, DNB, FRCS, PhD, of the department of cornea and refractive surgery at Narayana Nethralaya, India, and colleagues wrote in Indian Journal of Ophthalmology.
Before ocular surgery, subtle inflammation on the eye’s surface should be controlled with lubricating eye drops, eyelid wipes, diet changes and other methods as necessary. Image: Adobe Stock
“A growing body of evidence points to preexisting ocular surface inflammation as a key factor that predisposes patients to these complications, even when clinical signs are minimal or absent,” the researchers wrote. “Recognizing and managing preexisting inflammation is therefore not optional but essential for optimizing surgical outcomes.”
Based on a literature search and their own clinical data, Shetty and colleagues proposed a framework for a biological cleansing of the eye, with treatments escalating based on the severity of inflammation.
The plan ranges from lubricants for mild inflammation to systemic medications for the most severe inflammation. As levels increase, they recommend the following steps:
- lubricants, particularly with trehalose or sodium hyaluronate;
- switching to a low-carbohydrate/high-fat or ketogenic diet;
- nutraceuticals, including vitamin A palmitate and omega-3 fatty acids;
- lid hygiene, including medicated eyelid wipes;
- nonpharmacological treatments, such as thermal pulsation therapy and intense pulsed light therapy;
- topical immunomodulation, such as cyclosporine, tacrolimus, lifitegrast or steroids; and
- systemic medications, such as glucocorticoids.
“These interventions are not one-size-fits-all,” the researchers wrote. “Rather, they are tailored to the specific surgical context and even to the molecular profile of the inflammatory response.”
The researchers concluded that reducing the inflammatory load before surgery through biological cleansing is critical.
“Multiplex tear biomarker profiling-directed preoperative administration of pharmacologic products [and] use of lid hygiene, supplements and nutraceuticals can ultimately lead to a reduction in unwanted or adverse outcomes,” they wrote.
Perspective
This article highlights the importance of considering ocular surface inflammation during preoperative evaluation, even in patients who appear asymptomatic.
It supports a shift in preoperative care toward incorporating a proactive, inflammation-focused approach in which reducing baseline inflammatory load via “biological cleansing” may help mitigate complications such as postoperative discomfort, corneal haze and other suboptimal healing responses. For practicing optometrists, this is significant because it expands the role of preoperative care beyond identifying obvious symptoms or risk factors. Careful assessment and management of the ocular surface before referral may improve patient comfort, healing and visual recovery after surgery.
A key strength of this approach is its translational relevance: It connects known inflammatory mediators with real-world surgical outcomes and offers actionable interventions. The study also encourages clinicians to view the ocular surface as a modifiable factor that can influence surgical success. This perspective may prompt more proactive treatment of mild inflammation before patients undergo refractive or cataract procedures.
A limitation of the study is that many of its recommendations are based on biologically plausible concepts rather than standardized clinical protocols. The study’s conclusions remain largely conceptual. While the relationship between inflammation and surgical outcomes is compelling, there is limited evidence demonstrating which specific interventions are most effective or which patients benefit the most. As a result, the findings are best viewed as a framework for enhancing clinical decision-making rather than as definitive practice guidelines.
Jade Coats, OD, FAAO
The Exclusive Eye, Arkansas
Disclosures: Coats reports being on advisory boards for AbbVie, Alcon, Bausch + Lomb, Dompé, Harrow, Lenz Therapeutics, Novaliq Pharmaceuticals, Orasis Pharmaceuticals, Sun Pharmaceuticals, Tarsus Pharmaceuticals, Trukera Medical, Viatris and Zeiss and speaker bureaus for Alcon, Bausch + Lomb, Dompé, Harrow, Orasis Pharmaceuticals, Sun Pharmaceuticals, Tarsus Pharmaceuticals and Viatris.
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