Differential Characteristics, Mechanisms, and Clinical Strategies for Perioperative Dry Eye in Presenile Cataract and Age-Related Cataract

Background/Objectives: With the biphasic of cataract onset age, presenile cataract (40-55 years) and age-related cataract (≥70 years) demonstrate notable differences in perioperative dry eye manifestations. This review aims to systematically compare their differential characteristics, mechanisms, and management strategies. Methods: An indirect evidence synthesis was conducted, encompassing 71 clinical and mechanistic studies evaluating perioperative dry eye in these two patient populations. Results: Presenile patients predominantly present with evaporative dry eye secondary to meibomian gland dysfunction (55-70%), persisting for 3-6 months postoperatively, especially in subgroups with metabolic disorders, female sex, diabetes with rosacea, or preoperative anxiety. In contrast, age-related patients primarily exhibit mixed-type dry eye, with a shorter recovery period (1-3 months), characterized by corneal nerve demyelination and meibomian gland fibrosis. Mechanistically, the presenile group is associated with glandular functional overload, acute inflammation, and exogenous oxidative stress, while the age-related group shows degenerative degenerative atrophy, chronic low-grade inflammation (senescence-associated secretory phenotype, SASP), and impaired nerve regeneration. Conclusions: Perioperative dry eye exhibits inherent differences between presenile and age-related cataract patients, requiring age-stratified and subgroup-targeted management strategies for precise ocular surface care. However, due to the absence of direct head-to-head studies, these findings are derived from indirect evidence and should be considered hypothesis-generating.