Tear Film Changes Following Anterior Segment Surgery: A Comprehensive Literature Review of Pathophysiology, Clinical Features, and Recovery Time Course

Tear film instability and dry eye disease (DED) are among the most common postoper-ative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all alter ocular surface homeostasis through mechanisms including corneal denervation, inflammation, loss of goblet cells, and meibomian gland dysfunction. However, the severity and duration of postoperative dry eye vary significantly depending on the procedure performed. This comprehensive review of the literature summarises current evidence on pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Proce-dure-specific recovery trajectories are compared, distinguishing transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy are also reviewed. Understanding these distinct re-covery patterns allows for better surgical planning, improved patient counselling, and earlier intervention to reduce chronic postoperative dry eye and improve visual outcomes and patient satisfaction.