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.