TFOS Lifestyle: impact of elective medications and procedures on the ocular surface

José Alvaro P. Gomes*, Dimitri T. Azar, Christophe Baudouin, Etty Bitton, Wei Chen, Farhad Hafezi, Pedram Hamrah, Ruth E. Hogg, Jutta Horwath-Winter, Georgios A. Kontadakis, Jodhbir S. Mehta, Elisabeth M. Messmer, Victor L. Perez, David Zadok, Mark D.P. Willcox

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


The word “elective” refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

Original languageEnglish
Pages (from-to)331-385
Number of pages55
JournalThe Ocular Surface
Early online date18 Jun 2023
Publication statusPublished - Jul 2023


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