Postoperative dry eye disease (DED) is a common complication following cataract surgery with intraocular lens (IOL) implantation, adversely affecting ocular comfort and visual outcomes. Identifying risk factors and developing predictive models may facilitate targeted interventions and improved patient management.A retrospective analysis was conducted involving 376 cataract patients who underwent phacoemulsification with IOL implantation between January 2021 and December 2024. Patients were divided into a DED group (n = 158) and a non- DED group (n = 218) based on clinical evaluation, including the Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time (BUT), Schirmer I test (SIt), and fluorescein staining (FL) scores. Risk factors were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed from significant predictors and assessed by receiver operating characteristic (ROC) analysis, bootstrap internal validation, and decision curve analysis (DCA).The incidence of postoperative DED was 42.02% (Among the DED patients, 66.46% had mild DED, and 33.54% had moderate DED). Univariate analysis revealed that patients with DED were significantly older and had a higher prevalence of orthokeratology lens wear, diabetes, and rheumatoid arthritis, along with worse nuclear hardness grading, prolonged surgical time, abnormal ocular surface stress test (OSST) results, and impaired ocular surface parameters (all p < 0.05). Multivariate analysis identified orthokeratology lens wear (OR 3.472, p = 0.018), diabetes (OR 3.193, p = 0.016), diminished meibomian gland secretion (OR 3.228, p = 0.033), increased meibum viscosity (OR 3.548, p = 0.018), and elevated conjunctivochalasis grade (OR 3.092, p = 0.027) as independent predictors. The nomogram demonstrated an AUC of 0.761, with a sensitivity of 71.67% and specificity of 82.18%. Internal validation yielded a corrected C-index of 0.785, and DCA confirmed its clinical utility.In this study, orthokeratology lens wear, diabetes, and adverse ocular surface parameters, including diminished meibomian gland secretion, increased meibum viscosity, and elevated conjunctivochalasis grades were statistically associated with the occurrence of postoperative DED following IOL implantation. The nomogram developed from these associations demonstrated moderate discriminatory ability (AUC = 0.761) and good calibration. Prospective studies and external validation in diverse populations are warranted to confirm the model's generalizability and predictive performance.© 2025. The Author(s).