Ocular surface changes after lateral rectus muscle recession

BACKGROUND AND OBJECTIVE: To evaluate the changes in the integrated ocular surface/lacrimal gland unit after strabismus surgery. PATIENTS AND METHODS: The authors prospectively studied 23 patients undergoing lateral rectus muscle recession via fornix incision. At 1 week preoperatively and 1, 2, 3, and 4 months postoperatively, McMonnies' dry eye questionnaire, corneal fluorescein staining, corneal and conjunctival sensitivity with an esthesiometer, tear film break-up time, Schirmer I test, and impression cytology were performed. Impression cytology was performed in the inferotemporal and superotemporal bulbar conjunctiva and the goblet cell density (GCD) was measured. RESULTS: McMonnies' dry eye questionnaire scores increased significantly after surgery (P < .05 at 7 days and 1, 2, and 3 months) and returned to baseline at 4 months postoperatively. A temporary increase in corneal staining was observed, but it returned to baseline by 2 months. The tear film break-up time score was decreased at 1 week postoperatively and recovered slowly, but did not return to normal by 4 months. GCD in the inferotemporal area was significantly decreased until 2 months postoperatively. CONCLUSION: Tear film instability resulted from GCD depletion and conjunctival sensitivity could be one of the causative factors of ocular irritation symptoms after strabismus surgery. The ocular surface parameters returned to baseline at 4 months postoperatively.