Laser-assisted in situ keratomileusis surgery, commonly known as LASIK or laser eye surgery, aims to correct vision by permanently reshaping the eye’s cornea using a laser. Although generally safe, not everyone is an ideal candidate for LASIK surgery. Post-surgery, some people may experience dry eye symptoms.
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 into the back of the eye, increasing the eyes’ focusing power and improving visionTrusted Source.
While LASIK can improve vision, it may not suit everyone, including those with dry eye. In some cases, dry eye may also be a complication of LASIK surgery.
Dry eye typically refers to discomfort when tears do not sufficiently lubricate the eye. This may be due to the eye not producing enough tears, not producing the correct type of tears, or the tear film in the eye being affected. The symptoms of dry eye after LASIK can include:
- dryness
- irritation
- pain or discomfort
- ocular fatigue
- red eye
This article discusses the risk of dry eye after LASIK surgery and whether people with dry eye can have LASIK surgery.
Causes and risk factors for dry eye after LASIK
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Post-LASIK dry eye may be the result of several different mechanisms.
LASIK involves cutting through the cornea to create a flap, which may temporarily damage some nerves and cause a 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 dry eye symptoms.
Another possible reason for dry eye symptoms is that LASIK can change the shape of the eye, which may affect tears from spreading evenly. The surgery may also affect the amount of mucin on the eye, a crucial substance for tear stability.
Some evidence suggests that dry eye symptoms may result from a lack of lubrication and nerve damage caused during surgery. For some, the discomfort felt post-surgery might be a pain response due to the nerve damage.
The leading risk factor for developing dry eye after LASIK surgery is having preexisting dry eye symptoms before surgery.
Evidence also suggests that females are four times more likely to have dry eye symptoms post-surgery. A 2017 study also notes that the risk of dry eye increases beyond the age of 50.
The shape of a person’s eye may also influence the likelihood of dry eye, as those with lower or higher refractive errors may be at a higher risk of developing dry eye symptoms.
Other factors that can increase the risk of complications post-surgery include:
- keratoconus (a disease that causes thinning of the cornea)
- eye infections
- glaucoma
- cataract
Some autoimmune conditions, 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 higher chance of developing complications and may not be suitable candidates for LASIK.
Duration of dry eye after LASIK
It is common for a person to experience dry eye symptoms immediately after LASIK surgery. In most people, these symptoms tend to resolve after a few months. However, some evidence suggests that 10–40%Trusted Source of people may experience some dry eye symptoms 6 months after surgery. Although rare, dry eye symptoms can continue for over a year after surgery.
Treatment and prevention
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 ongoing treatment. Treatment for dry eyes 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 eye, and people can purchase them over-the-counter.
- Anti-inflammatory agents: Dry eye symptoms can result from inflammation of the eye, hindering tear production. An eye doctor may prescribe eye drop medications such as cyclosporine (Restasis) or lifitegrast (Xiidra) to reduce the inflammation.
- Punctual Plugs: These are small silicone or gel-like plugs that block the tear ducts to prevent tears from draining out of the eye, helping the eye remain moist.
- Autologous serum eye drops: These are bespoke eye drops made for individuals by using their blood. The aim is to create tear supplements as similar to a person’s natural tears as possible.
To reduce the risk of dry eye symptoms post-surgery, a person should make sure to take any medications given to them by their eye doctor and follow their instructions on how best to recover. Further steps that may reduce the risk of dry eye symptoms include:
- avoiding dry environments and using a humidifier
- remaining hydrated by drinking plenty of water
- getting enough sleep
- wearing wraparound sunglasses when outside to protect the eye from any irritants
Some evidence also suggests that the consumption of essential fatty acids, such as omega-3 fatty acids, may reduce dry eye symptoms for some people. People can take obtain these fatty acids by taking supplements or through foods, such as salmon and tuna.
Can a person get LASIK if they have dry eye?
An eye doctor will perform a comprehensive eye exam to determine whether a person is a good candidate for LASIK. This exam will include looking for signs of dry eye by examining the quality and quantity of tears on a person’s eye.
If a person has dry eye, they may still be a suitable candidate for LASIK. However, their eye doctor may advise that they receive treatment and control the pre-existing dry eye since the surgery can worsen the symptoms.
If a person cannot manage dry eye symptoms before surgery, their eye doctor may advise against LASIK surgery.
Alternative options
LASIK is one of the most common refractive surgeries. However, several alternative procedures aim to correct a person’s vision.
Small incision lenticule extraction (SMILE) works similarly to LASIK by creating a small incision in the cornea. Although research is mixed, there is evidence to suggest that SMILE may have a lower risk of dry eye symptoms post-surgery due to its lower involvement of the cornea.
Conductive keratoplasty is a procedure that modifies the shape of the cornea using radio waves. Although a less invasive surgery, conductive keratoplasty may still not suit 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 refer to it as 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 may occur for some people post ICL.
Not all these surgeries are suitable for everyone, and all have specific requirements. An eye doctor will take account of a person’s medical history and the features of a person’s eyes and help inform them on the best procedure.
Additionally, people can consider non-surgical options such as eyeglasses or disposable contact lenses.
When to contact a doctor
Dry eye is common after surgery and can last for several months. It is important that a person follows their doctor’s instructions during recovery and attends any follow-up appointments. A person should see a doctor if they experience worsening symptoms or if pain and other symptoms remain for many months after surgery.
Summary
LASIK is a popular and generally safe procedure that can offer long-lasting results for many people. However, dry eye symptoms are common after surgery. In many cases, these symptoms resolve on their own. If the symptoms do not resolve, many treatment options are available to help manage them.
If a person already has preexisting 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 eye doctor may approve them for LASIK surgery.
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