Reliability and usability of telemedicine evaluations for facial dystonia.

This study investigated telemedicine reliability and usability in evaluating facial dystonia grading and treatment complications. Eighty-two telemedicine recordings from 43 adults with blepharospasm (12, 28%) and hemifacial spasm (31, 72%) were obtained (mean age 64.5 ± 9.3 years, 32 females [64%]). Two recorded in-hospital telemedicine visits were arranged with in-person visits at baseline and 4-6 weeks. After 8 weeks, neuro-ophthalmologists who performed the in-person visits re-evaluated the telemedicine video records. Intra-rater agreements in assessing spasm gradings were moderate (severity: kappa = 0.42, 95% confidence interval [CI] 0.21-0.62; frequency: kappa = 0.41, 95% CI 0.21-0.61) with substantial agreement in detecting lagophthalmos (kappa = 0.61, 95% CI 0.36-0.86). Adding symptoms to signs increased sensitivity and negative predictive value (NPV) in detecting lagophthalmos (67%-100% and 94%-100%) and drooping lips (38%-75% and 94%-96%), respectively. Thai version Telehealth Usability Questionnaire showed high mean usability score of 6.5 (SD 0.8) out of 7. Telemedicine could further be developed as an alternative platform to evaluate facial dystonia.

Changes in Ocular Biomarkers from Normal Cognitive Aging to Alzheimer's Disease: A Pilot Study.

Purpose: To identify ophthalmic findings in Alzheimer's type dementia (ATD) compared to normal subjects. Patients and Methods: This comparative descriptive study included participants from the institution's cognitive fitness center. Complete ophthalmic examinations were performed. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to analyze retinal thickness and vascular density. The Ocular Surface Disease Index (OSDI) score and tear breakup time (TBUT) were used to assess dry eye. The blink rate was counted by a well-trained observer. Cognitive function was evaluated using the Thai Mental State Examination (TMSE) score. Correlation analysis was performed to compare OCT, OCTA parameters, and TMSE. Results: We included 24 ATD patients and 39 normal participants as a control group by age and sex-matched. The prevalence of dry eye using the Asia Dry Eye Society criteria was 15% and 13% in normal and ATD patients, respectively. The differences in OSDI scores, TBUT, and blink rate between the two groups were not statistically significant. The parafoveal and perifoveal macular thickness of the ATD group were significantly lower than that of the control group (p<0.01). All parameters of the vessel density of the ATD group were significantly lower than in the control group, including the whole macular vessel density (p<0.01), optic disc vessel density at the nerve head level (p<0.01), and optic disc vessel density at the radial peripapillary capillary level (p<0.05). After age adjustment, there were no statistically significant differences in all the OCT and OCTA parameters. There was a positive correlation between retinal thickness and vessel density in the macular and optic disc region and TMSE scores. Conclusion: Perifoveal and parafoveal retinal thickness might be more sensitive than peripapillary RNFL thickness to detect neurodegenerative changes in patients with ATD. Macular thickness and vessel density reduction were also positively correlated with cognitive decline.

Health-related quality of life of daily-life-affected benign essential blepharospasm: Multi-center observational study.

PURPOSE: To compare Thais' health-related quality of life (HRQOL) and severity grading, efficacy and safety in daily-life-affected benign essential blepharospasm (BEB) patients at baseline and after Botulinum toxin type A (BTX-A) treatment. DESIGN: Prospective-observational study. PARTICIPANTS: BEB patients with Jankovic rating scale (JRS) at least 3 in both severity and frequency graded from 14 institutes nationwide were included from August 2020 to June 2021. METHODS: Demographic data, HRQOL evaluated by the Thai version of EQ-5D-5L and NEI-VFQ-25 questionnaires, and severity grading score evaluated by Jankovic rating scale (JRS) at baseline, 1, and 3 months after the treatment were collected. The impact of the BTX-A injections and their complications were recorded. RESULTS: 184 daily-life-affected BEB patients were enrolled; 159 patients (86.4%) had complete data with a mean age of 61.40±10.09 years. About 88.05% were female, and 10.1% were newly diagnosed. Most of the patients had bilateral involvement (96.9%) and 12.6% had history of BEB-related accident. After BTX-A treatment, HRQOL improved significantly in 4 dimensions of EQ-5D-5L, except self-care. The EQ_VAS (mean±SD) was 64.54±19.27, 75.13±15.37, 73.8±15.85 (p<0.001) and EQ-5D-5L utility score was 0.748±0.23, 0.824±0.19 and 0.807±0.19 at baseline, 1, 3 months after treatment, respectively. From NEI-VFQ-25, HRQOL also improved in all dimensions, except eye pain. The JRS improved in all patients. Self-reported minor adverse events were 22.6%, which mostly resolved within the first month. CONCLUSION: Daily-life-affected BEB impacted HRQOL in most dimensions from both generic and visual-specific questionnaires. BTX-A treatment not only decreased disease severity, but also improved quality of life.

Evaluation of Psychometric Properties of Thai Version Telehealth Usability Questionnaire (T-TUQ).

This cross-sectional validation study aimed to translate, cross-culturally adapt, and investigate the psychometric properties of a Thai version of the Telehealth Usability Questionnaire (T-TUQ). Two hundred and ten Thai participants, mean age of 61.2±15.2 years, were recruited from three specialty clinics: 50 (23.8%) hematology, 70 (33.3%) movement disorders, and 90 (42.9%) general neurology. The T-TUQ was translated from the original English version to produce a Thai language version. Back translation and pilot cognitive interviews were completed. All five subscales (usefulness, ease of use, effectiveness, reliability, and satisfaction) showed excellent internal consistency (alpha >0.80), displayed by Cronbach's alpha coefficient of 0.83, 0.94, 0.86, 0.83, and 0.92, respectively. For construct validity, exploratory factor analysis revealed two dimensions from eigenvalues and scree plot, defined as utility and accessibility subscales. In conclusion, the T-TUQ could be a reliable and valid instrument to evaluate the usability of telehealth with a Thai population.

Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis with COVID-19 infection: A case report and literature review.

Purpose: To demonstrate the association between SARS-CoV-2 infection and MOG antibody associated optic neuritis. Observations: A 35-year-old Thai woman presented with acute blurred vision of her left eye with pain on eye movement for six days and had dry cough for one week before the onset of visual loss. Her visual acuity was 20/32 in the right eye and counting fingers with a RAPD in the left eye. She had bilateral disc swelling, more prominent on the left eye. A CT scan of the brain and orbits showed swollen optic nerve sheath complex both eyes. Serology test was positive for serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody. Her nasopharyngeal swab for SARS-CoV-2 PCR was also positive. The diagnosis of SARS-CoV-2 associated MOG antibody optic neuritis was made. Conclusions and importance: This case of MOG antibody associated optic neuritis after COVID-19 infection, along with several other cases reported in the literature, suggests that there may be an association between COVID-19 infection and MOG antibody-associated disease. However, larger case-controlled studies are required to confirm this association.

Interobserver and Intra-Observer Reliability of Eyelid Tests for Ocular Myasthenia Gravis.

BACKGROUND: Lid fatigability test (LFT), Cogan lid twitch (CLT), and forced eyelids closure test (FECT) are simple clinical screening tests for ocular myasthenia gravis (OMG). However, these tests are subjectively interpreted. We thus evaluated the interobserver and intra-observer reliability of each test. METHODS: The 3 eyelid tests were performed in ptotic patients associated with various conditions, including OMG and others. Video clips of all tests were recorded using smartphone with built-in camera in the following order; LFT, CLT, and FECT. All video clips were distributed to 3 neuro-ophthalmologists and 3 general ophthalmologists, who were trained to evaluate the tests using a single standard instruction. After 3 months, all video clips were re-organized for the second evaluation. Interobserver and intra-observer reliability were calculated using Cohens' Kappa coefficient and Fleiss Kappa statistic. RESULTS: The 3 eyelid tests were performed and recorded in 35 patients, which included the diagnosis of OMG, levator muscle dehiscence, partial oculomotor nerve palsy, and Horner syndrome. CLT received moderate-to-substantial interobserver reliability in neuro-ophthalmologist group (Fleiss Kappa 0.77 [95% CI 0.60-0.94] and 0.66 [95% CI 0.46-0.85] in first and second evaluation respectively), but the results varied in general ophthalmologist group (Fleiss Kappa 0.58 [95% CI 0.37-0.79] and 0.54 [95% CI 0.33-0.76] in first and second evaluation respectively). FECT and LFT received lower interobserver reliability in both groups. CLT also received moderate-to-almost perfect intra-observer reliability in neuro-ophthalmologist group (Cohen Kappa 0.55, 0.58, and 0.92), whereas FECT and LFT received lower intra-observer reliability. The intra-observer reliability varied among general ophthalmologists for all 3 eyelid tests. CONCLUSIONS: CLT is the most reliable test among the 3 eyelid tests. However, all tests should be interpreted with caution by general ophthalmologists.

Sensitivity and Specificity of New Visual Field Screening Software for Diagnosing Hemianopia.

PURPOSE: To assess the diagnostic accuracy of visual field results generated by the newly developed software (CU-VF) and the standard automated perimetry (SAP) for detecting hemianopia. PATIENTS AND METHODS: Forty-three subjects with hemianopia and 33 controls were tested with the CU-VF software on a personal computer and SAP. Hemianopia was defined as the presence of a hemianopic field respecting the vertical meridian on SAP with the corresponding neuroimaging pathology as evaluated by 2 neuro-ophthalmologists. Results of CU-VF were independently evaluated by 2 neuro-ophthalmologists, 1 general ophthalmologist, and 1 general practitioner in terms of the presence of hemianopia. Sensitivity, specificity, and kappa coefficient for inter-observer reliability were calculated. Satisfaction and ease of use were evaluated with a visual analog-scale questionnaire and analyzed using paired t-test. RESULTS: The sensitivity (95% CI) and specificity (95% CI) of the CU-VF to detect hemianopia was 74.42% (58.53-85.96) and 93.94% (78.38-99.94). Kappa coefficient between neuro-ophthalmologists versus general ophthalmologist and general practitioner were 0.71 and 0.84, respectively. The mean (SD) test duration was 2.25 (0.002) minutes for the CU-VF and 5.38 (1.34) minutes for SAP (p < 0.001). Subjects reported significantly higher satisfaction and comfort using the CU-VF software compared to SAP. CONCLUSION: The CU-VF screening software showed good validity and reliability to detect hemianopia, with shorter test duration and higher subject satisfaction compared to SAP.

Vision-related quality-of-life in pediatric primary brain tumor patients.

PURPOSE: Brain tumors are the leading cause of death from childhood cancer. Although overall survival has improved due to earlier detection, better therapies, and improved surveillance, visual dysfunction and impaired vision-related quality-of-life (VR-QOL) are often unrecognized in children. This project investigated VR-QOL in pediatric brain tumor patients. METHODS: We evaluated visual impairment and quality-of-life (QOL) in a quality improvement project at one tertiary care center. Patients ≤ 18, greater than 6 months from diagnosis of brain tumor, excluding intrinsic anterior visual pathway tumors, underwent standardized neuro-ophthalmologic examination. Health-related QOL (HR-QOL) (PedsQL Brain Tumor Module) and VR-QOL questionnaires [CVFQ (Children's Visual Function Questionnaire) in children < 8, and EYE-Q in children 8-18] were obtained from patients and parents. RESULTS: Among 77 patients, craniopharyngiomas (n = 16, 21%) and astrocytomas (n = 15, 20%) were the most common tumors. Among 44/77 (57%) visually impaired children, 7 (16%) were legally blind. Eye-Q median score was 3.40 (interquartile range 3.00-3.75), worse than average scores for normal children. Eye-Q score decreased 0.12 with every 0.1 increase in logMAR visual acuity (p < 0.001). Patients who were legally blind had a significantly lower Eye-Q score than those who were not [0.70 vs. 3.44 (p < 0.001)]. Cognitive HR-QOL scores decreased 1.3 for every 0.1 increase in logMAR visual acuity (p = 0.02). CONCLUSIONS: Pediatric brain tumor patients' vision, HR-QOL, and VR-QOL were often severely affected even when tumors were considered cured. Visual acuity and legal blindness correlated with VR-QOL. Systematic neuro-ophthalmologic examinations in pediatric primary brain tumor patients are necessary to facilitate early preventative and corrective ophthalmologic interventions.

Dry Eye Disease in Hemifacial Spasm Patients Treated with Botulinum Toxin Type A.

PURPOSE: To assess the impact of botulinum toxin type A (BTX-A) on signs and symptoms of dry eye (DE) in affected eye of hemifacial spasm (HFS) patients and to compare the prevalence of DE between affected and non-affected eye in HFS patients. PATIENTS AND METHODS: This prospective study included participants with unilateral HFS, who received BTX-A injection as a treatment. The eyes ipsilateral to the spasm side were used as studied eyes and the contralateral eyes were used as controls. The Ocular Surface Disease Index (OSDI) score, tear break-up time (TBUT), corneal fluorescein staining, and Schirmer I test were measured at baseline, 1 and 3 months after BTX-A injection. Fluorescein clearance test (FCT) was evaluated at baseline and at 1 month after BTX-A injection. RESULTS: Thirty-one participants (6 males and 25 females; mean age 61±10 years) were included. The prevalence of DE according to the Asia Dry Eye Society was not significantly different between affected (37.93%) and non-affected eyes (27.6%); P=0.083. At baseline, there was no significant difference in TBUT, Schirmer test, basal tear secretion, presence of delayed tear clearance, and presence of reflex tear secretion between affected and non-affected eyes, while significant difference in Oxford scheme grade was observed (P=0.031). OSDI score, TBUT, Oxford scheme grade, and Schirmer test at 1 month (P=0.817, 0.796, 0.534, 0.556), and 3 months (P=0.803, 0.904, 0.936, 0.684) after BTX-A injection did not significantly change from baseline in affected eyes. FCT results were not significantly different between baseline and at 1-month follow-up in both groups. All findings were corresponding in both naïve and long-term botulinum toxin injection groups. CONCLUSION: We found no significant effect of BTX-A on signs and symptoms of DE in patients with HFS. Moreover, there was no significant association between HFS and DE. However, we found significant corneal surface damage in the affected eyes, which emphasized importance of ocular surface evaluation and prompt treatment in HFS patients.

Complications of Preseptal Versus Pretarsal Botulinum Toxin Injection in Benign Essential Blepharospasm: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to compare ocular complications and efficacy of preseptal (PST) versus those of pretarsal (PTS) botulinum toxin type A (BoNT-A) therapy in cases of benign essential blepharospasm (BEB). DESIGN: Randomized clinical trial. METHODS: Setting: university hospital. PATIENTS: 24 participants with BEB were enrolled from August 2019 to June 2020. All patients and the outcome evaluator were masked to the injection allocation. INTERVENTIONS: for each participant, 1 eye was randomized to receive PST BoNT-A injection, and the fellow eye received PTS BoNT-A injection of the same amount from a single investigator. At baseline, 1, and 3 months after the injection, we collected the symptoms of tearing, lagophthalmos, ptosis, and diplopia and measured margin-to-reflex distance (MRD) 1 and 2 (mm), degree of lagophthalmos (mm), presence of ectropion, entropion, limitation of ocular motility, tear film breakup time (second), Schirmer's test (mm) , ocular surface staining scores (Oxford's scheme), and Jankovic rating scale of both eyes separately. Main outcome measurements were complications of the injection. RESULTS: There were statistically significant higher rates of self-reported lagophthalmos in PTS (n = 12; 52.17%) than in PST (n = 7; 30.43%) BoNT-A injections (P = .024) and significantly higher estimated measurements of lagophthalmos in PTS (0.59 mm; 95% confidence interval [CI]: 0.44-0.72) than in PST (0.26 mm; 95% CI: 0.12-0.40) injection at 1 month using an interaction model (Bonferroni-corrected P = .001). No significant differences in the efficacy and other complication outcomes between the injection locations were observed. CONCLUSIONS: PTS BoNT-A injection had a higher rate of lagophthalmos than PST BoNT-A injection for BEB.

Factors Affecting Generalization of Ocular Myasthenia Gravis in Patients With Positive Acetylcholine Receptor Antibody.

PURPOSE: To evaluate the associated factors of conversion of ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) among patients with seropositive acetylcholine receptor antibody (AchR Ab). DESIGN: Retrospective cohort study. METHODS: Setting: Retrospective chart review. PATIENT: Seventy-one OMG patients with seropositive AchR Ab presented during July 2009 and December 2016. The exclusion criteria were patients who (1) first presented with GMG, (2) were unable to identify the time of onset of OMG or GMG, (3) were unable to provide information about previous treatments before the onset of GMG, and (4) had incomplete or lost medical records. OBSERVATION PROCEDURE: We collected demographic and clinical characteristics, including onset of OMG and GMG, presence of other autoimmune disorders, history of smoking, presence of thymic abnormalities, and medications received. MAIN OUTCOME MEASURES: Conversion to GMG and time to conversion. RESULTS: Thirty-six patients experienced conversion to GMG. Overall incidence of GMG was 14 (95% confidence interval [CI] 10.09-19.4) per 100 patient-years. Probability of conversion at 2 years was .37 (95% CI .27-.49). Overall median conversion time was 4.97 years. Cox proportional hazard model showed that risk factors were female sex (HR 2.52, 95% CI 1.04-6.10), history of smoking (HR 3.42, 95% CI 1.40-8.45), and thymic abnormalities (HR 1.82, 95% CI 0.91-3.67). Protective factors against conversion to GMG were receiving immunosuppressive agents (HR 0.42, 95% CI 0.19-0.97) and pyridostigmine (HR 0.37, 95% CI 0.14-0.93). CONCLUSIONS: OMG patients with seropositive AchR Ab should be informed that taking pyridostigmine and/or immunosuppressive agents as well as smoking cessation might prevent conversion to GMG.

Long-term outcome of full tendon vertical rectus transposition with Foster suture in unilateral complete sixth cranial nerve palsy.

PURPOSE: To evaluate the success rate and long-term motor and sensory outcomes of the full tendon vertical rectus transposition (VRT) with Foster suture for unilateral complete sixth cranial nerve palsy. PATIENTS AND METHODS: We reviewed the medical records of patients with unilateral acquired sixth cranial nerve palsy who underwent unilateral full tendon VRT with Foster suture between 2005 and 2016 and had a follow-up of ≥2 years. Data on pre- and postoperative diplopia, face turn, ocular deviation, and limitation of abduction were collected. A successful outcome was defined as a horizontal deviation ≤10 prism diopter (PD) of ortho in a primary position at distance and absence of diplopia. RESULTS: A total of 20 patients were included in this study. Median (IQR) preoperative deviation was esotropia 65 (40-130) PD, which improved to 10 (-4 to 45) PD postoperatively. Median (IQR) improvement of esotropia was 54 (30-76) PD (P<0.001). Median (IQR) preoperative limitation of abduction was -15° (-22.5° to 10°; negative value means before reaching midline), which improved to 15° (7.5°-45°) pass midline postoperatively. Median (IQR) improvement of abduction deficit was 26° (15°-35°) (P<0.001). Successful surgical outcomes were obtained in eleven patients (55%). All patients in the non-successful group (n=9, 45%) had residual esotropia. Two of them underwent additional bilateral medial rectus recession. No postoperative vertical deviation or torsional diplopia was observed. CONCLUSION: In our series, the full tendon VRT with Foster suture in unilateral complete sixth cranial nerve palsy resulted in significant improvement of the ocular alignment and range of abduction over the 2-year follow-up period.

Atypical pituitary adenoma with orbital invasion: Case report and review of the literature.

Pituitary adenoma invasion into the orbit is a rare phenomenon with only 22 cases, including the present case, in the literature. Our case is a 31-year-old man who presented with biopsy-proven atypical pituitary adenoma invading the right orbit after a prior resection. We compare his clinical course with previous cases and discuss clinical features, radiological features, management considerations, histologic features, and prognosis. Cases are organized by specific pituitary tumor type to aid in determining appropriate management. Early surgical intervention is the key, especially in the setting of pathologic features indicating aggressive tumor behavior or worsening visual function but is generally not indicated in prolactin-secreting adenomas that may respond to medical therapy. The role of radiation therapy is not fully established; however, it should be strongly considered in conjunction with or after surgery, especially in cases where complete resection is not achieved or histological and molecular analyses indicate a high likelihood of recurrence. More uniform and comprehensive data about management and outcomes are needed to determine the optimal treatment approach for this rare entity.

The Effects of Primary Brain Tumors on Vision and Quality of Life in Pediatric Patients.

Brain tumors are the leading cause of death from childhood cancer. Overall survival has improved due to earlier detection, better therapies, and improved posttreatment surveillance. Permanent sequelae of the tumor and its treatment may cause severe impairment and decreased quality of life (QoL). Pediatric primary brain tumor patients' vision can be severely affected, even when the tumor location does not primarily involve the visual pathway. Visual dysfunction and impaired vision-related QoL may not be detected or screened for in children with primary brain tumors for many reasons, including examination difficulty and lack of awareness. The authors review the ophthalmic presenting symptoms, effects on vision, and quality of life in pediatric patients with primary brain tumors. They also describe and emphasize the importance of systematic neuro-ophthalmologic examinations in this population, which may improve long-term visual and QoL outcomes through earlier interventions.

Prevalence and Associated Factors of Neurovascular Contact in Patients With Hemifacial Spasm.

PURPOSE: This study aimed to observe the prevalence and associated factors of neurovascular contact hemifacial spasm (HFS). DESIGN: This was a cross-sectional analytical study. METHODS: Medical records of patients with HFS in a neuro-ophthalmology clinic in Thailand between June 2008 and June 2012 were reviewed. A positive magnetic resonance imaging finding was defined as an adjacent variant vessel that directly compressed or placed pressure on the affected facial nerve. Prevalence and associated factors were analyzed. RESULTS: A total of 60 participants were enrolled, composed of 12 male patients and 48 female patients with a median age of 54 years [interquartile range (IQR), 44.0-64.75] and a disease duration ranging from 4 months to 16 years (median, 2 years; IQR, 1.0-6.0). The prevalence of neurovascular contact HFS was 41.7%. Neurovascular contact HFS was more prevalent among women, with an overall ratio of 3.33. In age group analysis, the prevalence was higher among older patients. In univariate analysis, right-sided symptoms and diabetes mellitus were statistically significant in their association with neurovascular contact HFS (P = 0.040 and P = 0.029, respectively). Right-sided symptoms were significant in a multiple logistic regression analysis (P = 0.038), with an odds ratio of 3.30 [95% confidence interval (CI), 1.07-10.15]. Diabetes mellitus was not statistically significant (P = 0.051), with an odds ratio of 9.99 (95% CI 0.99-96.34). CONCLUSIONS: The prevalence of neurovascular contact in patients with HFS was 41.7%. Right-sided symptoms were significantly associated with this condition.

Outcomes of 3 or 4 Horizontal Muscles Surgery in Large-Angle Exotropia.

PURPOSE: To evaluate motor and sensory outcomes of 3 or 4 horizontal muscles surgery for the treatment of large-angle exotropia and to evaluate factors influencing the success rate and the relationship between initial postoperative and final motor outcomes. DESIGN: A retrospective analytical study. METHODS: Medical records of patients with primary large-angle exotropia [>50 prism diopters (PD)] who had 3 or 4 horizontal muscles surgery were reviewed. Motor outcomes were categorized as successful (esotropia 1-8 PD, orthotropia or exotropia 1-10 PD), acceptable (exotropia 11-20 PD), and poor (esotropia >8 PD or exotropia >20 PD). Results were evaluated only at the last follow-up visit if patients were followed up for less than 2 years. Those who were followed up for more than 2 years were evaluated at both the 2-year and final follow-up visits. Factors influencing the success rate and the relationship between initial postoperative and final motor outcomes were analyzed. RESULTS: A total of 36 patients were enrolled in this study. The median follow-up time was 18 months (range, 3-60 months). The success rate was 69% at the last follow-up and 75% at the follow-up at 2 years, respectively. Stereopsis improved in 43% at the last follow-up and 56% at 2 years. Initial postoperative deviation was found to correlate with the success rate at the last follow-up (P = 0.018). Initial postoperative overcorrection of 8 to 14 PD had the highest possibility of gaining successful final motor outcomes. CONCLUSIONS: Three or 4 horizontal muscles surgery in large-angle exotropia can achieve successful motor outcomes and improve stereopsis. Surgeons should aim for initial overcorrection in order to maximize long-term success.

Incidence and pattern of dry eye after cataract surgery.

PURPOSE: To evaluate the incidence and severity pattern of dry eye after phacoemulsification. SETTING: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. DESIGN: Prospective descriptive study. METHODS: Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia. RESULTS: Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6-16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively). CONCLUSIONS: The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.