LASIK and dry eye: causes, risks and prevention

Laser-assisted keratomileusis in situ surgery, commonly known as LASIK or laser eye surgery, aims to correct vision by permanently reshaping the cornea of ​​the eye using a laser. Although generally safe, not everyone is an ideal candidate for LASIK surgery. After surgery, some people may have symptoms of dry eye.

LASIK surgery is a procedure that uses lasers to help correct refractive errors in the eye and improve the eyes’ ability to focus.

During the LASIK procedure, a special laser reshapes the cornea to allow light to focus on the back of the eye, thus increasing the focusing power of the eyes and improve eyesight.

Although LASIK can improve vision, it may not be suitable everyone, including those with dry eyes. In some cases, dry eye can also be a complication of LASIK surgery.

Dry eye usually refers to discomfort when tears do not sufficiently lubricate the eye. This could be because the eye is not producing enough tears, is not making the right type of tears, or the tear film in the eye is affected. Symptoms of dry eye after LASIK can include:

  • drought
  • irritation
  • pain or discomfort
  • eye strain
  • Red eyes

This article discusses the risk of dry eye after LASIK surgery and whether people with dry eye can have LASIK surgery.

Learn more about dry eye and how to treat it here.

Post-LASIK dry eye can be the result of several different mechanisms.

LASIK involves cutting the cornea to create a flap, which can temporarily damage certain nerves and cause reduced sensation. Due to this loss of sensitivity, the eye may not recognize the need for moisture, so it does not produce enough tears, causing symptoms of dry eye.

Another possible reason for dry eye symptoms is that LASIK can change the shape of the eye, which can prevent tears from spreading evenly. Surgery can also affect the amount of mucin in the eye, a substance crucial for the stability of tears.

Some evidence suggests that symptoms of dry eye can result from a lack of lubrication and nerve damage caused during surgery. For some, the discomfort experienced after surgery can be a painful response due to nerve damage.

The main risk factor for developing dry eye after LASIK surgery is having pre-existing dry eye symptoms before surgery.

Evidence also suggests that women are four times more likely to have symptoms of dry eye after surgery. A 2017 study also notes that the risk of dry eye increases beyond age 50.

The shape of a person’s eye can also influence the likelihood of dry eye because people with lower or higher refractive errors may be at a higher risk for developing symptoms of dry eye.

Other factors that may increase the risk of postoperative complications understand:

  • keratoconus (a disease that causes the cornea to thin)
  • eye infections
  • glaucoma
  • cataract

Some autoimmune diseases, such as Sjogren’s syndrome and diabetes, can affect tear production and make it difficult for the eye to heal after surgery.

People with such conditions, especially if the symptoms are not well controlled, may have a more likely to develop complications and may not be suitable candidates for LASIK.

Learn more about diabetic retinopathy here.

It is common for a person to have symptoms of dry eye immediately after LASIK surgery. In most people, these symptoms tend to go away after a some months. However, some evidence suggests that 10-40% people may have symptoms of dry eye 6 months after surgery. Although rare, symptoms of dry eye can persist for more than a year after surgery.

Dry eye after LASIK tends to be temporary and may only require treatment for a few months. However, people with chronic dry eye may require continued treatment. Treatment for dry eye involves adding artificial tears, increasing tear production, and treating any inflammation in the eye. Treatment options May include:

  • Eye drops: These supplements help lubricate the surface of the cornea. Tear supplements tend to be the first treatment for dry eyes, and people can buy them over the counter.
  • Anti-inflammatory agents: Symptoms of dry eye can result from inflammation of the eye, making it harder to produce tears. An eye doctor may prescribe eye drops such as cyclosporine (Restasis) or lifitegrast (Xiidra) to reduce inflammation.
  • One-off catches: These are small silicone or gel plugs that block the tear ducts to prevent tears from leaking out of the eye, thus helping the eye to stay moist.
  • Autologous serum eye drops: These are custom made eye drops designed for individuals using their blood. The goal is to create tear supplements that are as similar as possible to a person’s natural tears.

To reduce the risk of dry eye symptoms after surgery, a person should make sure to take all of the medications given to them by their eye doctor and follow their instructions on how best to recover. Other steps that can reduce the risk of dry eye symptoms includes:

  • avoid dry environments and use a humidifier
  • staying hydrated by drinking plenty of water
  • get enough sleep
  • wear wraparound sunglasses outside to protect the eyes from any irritants

There is also some evidence to suggest that consuming essential fatty acids, such as omega-3 fatty acids, may reduce symptoms of dry eye in some people. People can get these fatty acids by taking supplements or through foods such as salmon and tuna.

Find out here if fish oils can treat dry eyes.

An ophthalmologist will perform a complete eye exam to determine if a person is a good candidate for LASIK. This exam will include looking for signs of dry eye by looking at the quality and quantity of tears in a person’s eye.

If a person has dry eyes, they may still be a suitable candidate for LASIK. However, their ophthalmologist may advise them to receive treatment and control the pre-existing dry eye, as surgery can make symptoms worse.

If a person cannot manage the symptoms of dry eye before surgery, their eye doctor may advise against LASIK surgery.

Read more about the possibility of curing dry eyes here.

LASIK is one of the most common refractive surgeries. However, there are several alternative procedures aimed at correcting a person’s vision.

Small Incision Lens Removal (SMILE) works similarly to LASIK by creating a small incision in the cornea. Even if research is mixed, there is some evidence to suggest that SMILE may have a lower risk of dry eye symptoms after surgery due to its less corneal damage.

Conductive keratoplasty is a procedure that changes the shape of the cornea using radio waves. Although it is a less invasive surgery, conductive keratoplasty may not be suitable for everyone and results may not last.

A doctor can also surgically implant a phakic contact lens in the eye to correct a person’s vision. Some people call it phakic intraocular lens (PIOL) or implantable contact lenses (ICL).

Since the procedure does not affect the cornea, the risk of dry eye symptoms may be lower. However, evidence suggests that dry eye can occur in some people after ICL.

Not all of these surgeries are suitable for everyone and all have specific requirements. An ophthalmologist will consider a person’s medical history and the characteristics of a person’s eyes and help educate them on the best procedure to follow.

Additionally, people may consider non-surgical options such as eyeglasses or disposable contact lenses.

Learn more about glasses and contact lenses here.

Dry eye is common after surgery and can last for several months. It is important that a person follow their doctor’s instructions during recovery and attend all follow-up appointments. A person should see a doctor if their symptoms worsen or if pain and other symptoms persist for several months after surgery.

LASIK is a popular and generally safe procedure that can provide long-lasting results for many people. However, symptoms of dry eye are common after surgery. In many cases, these symptoms go away on their own. If the symptoms do not go away, there are many treatment options available to help manage them.

If a person already suffers from a pre-existing dry eye, they may not be a suitable candidate for LASIK surgery and may instead consider other options. However, if they can manage their dry eye symptoms, their ophthalmologist can approve them for LASIK surgery.


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