To investigate corneal surface changes and subjective symptoms after small incision cataract surgery and to compare the changes between clear corneal incision and corneoscleral incision.

The present prospective randomized study included 18 eyes of 18 patients with corneoscleral incision (Group 1) and 25 eyes of 25 patients with clear corneal incision (Group 2). All patients were examined for tear break-up time (BUT), Schirmer test, cornea and conjunctiva fluorescein staining, and dry eye symptoms using the Ocular Surface Disease Index (OSDI). All values were compared before surgery and at one day, one week, four weeks, and seven weeks after surgery.

BUT decreased significantly ( p < 0.05) and fluorescein staining scores increased significantly ( p < 0.05) at postoperative day 1. The values of BUT and fluorescein staining returned to the preoperative level at postoperative week 3 in Group 1. In Group 2, fluorescein staining scores returned at one week and BUT returned to the preoperative level at postoperative week 3. Postoperative Schirmer test results were unchanged compared to preoperative values, and there was no difference between the two groups. OSDI scores significantly improved compared to preoperative scores at postoperative one week. In Group 1, the scores improved at postoperative one week ( p < 0.05) compared to those in Group 2 at postoperative three weeks ( p < 0.05).

Phacoemulsification with a small incision induced transient corneal surface changes and tear film instability, but the changes returned to the preoperative level at postoperative three weeks. Dry eye symptoms also improved at postoperative one week. The changes lasted longer with clear corneal incision than with corneoscleral incision but returned to the preoperative level at postoperative three weeks in both groups.