Unseen Consequences: The Expanding Burden of Iatrogenic Dry Eye Disease in Surgical and Cosmetic Practice

Iatrogenic dry eye disease (DED) has emerged as a significant but overlooked complication in both ophthalmic surgery and aesthetic medicine. Characterized by disruption of tear film homeostasis, ocular surface inflammation, and neurosensory dysfunction, this condition may arise acutely or chronically following medical interventions. The Tear Film and Ocular Surface Society Dry Eye Workshop II and III reports have highlighted iatrogenic DED as a distinct clinical entity, underscoring its multifactorial etiology and the need for tailored risk mitigation strategies. Refractive procedures such as laser in situ keratomileusis and photorefractive keratectomy are frequently implicated due to corneal nerve transection and subsequent hypoesthesia, which impair blink dynamics and lacrimal gland feedback. Cataract surgery, though largely safe, contributes via surface desiccation, intraoperative light exposure, and topical medication toxicity. Oculoplastic interventions, including blepharoplasty, introduce mechanical alterations that disrupt eyelid function and tear film distribution. Moreover, the growing demand for periocular cosmetic procedures such as botulinum toxin injections and permanent eyeliner tattooing has introduced additional risks, particularly in individuals with preexisting meibomian gland dysfunction or marginal tear function. Emerging evidence suggests that the cumulative effect of repeated exposures and inadequate preoperative screening has led to a rise in persistent ocular surface morbidity. Prevention therefore necessitates a multidisciplinary approach encompassing ophthalmologists, dermatologists, plastic surgeons, and primary care providers. Systematic pretreatment ocular surface assessment, patient counseling, and adoption of minimally disruptive techniques are essential. By integrating evidence-based risk stratification into routine care, clinicians can significantly reduce the burden of iatrogenic DED and preserve long-term visual quality and patient satisfaction in the face of expanding therapeutic and cosmetic practices.