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. While generally safe, not everyone is an ideal candidate for LASIK surgery. After surgery, some people may experience symptoms of dry eyes.

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

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

While LASIK can improve vision, it is may not be suitable everyone, including those with dry eye. In some cases, dry eye can 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 is affected. Dry eye symptoms after LASIK can include:

  • dryness
  • irritation
  • pain or discomfort
  • eye fatigue
  • Red eyes

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

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

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

LASIK involves cutting through the cornea to create a flap, which can temporarily damage some nerves and cause reduced sensation. Due to this loss of sensation, 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 can affect the spread of tears evenly. The surgery can also affect the amount of mucin on the eye, a substance crucial 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 after surgery may be a response to pain 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 females are four times more likely to have dry eye symptoms after surgery. A study 2017 also notes that the risk of dry eyes increases beyond the age of 50.

The shape of a person’s eye can also affect the likelihood of dry eye, as those with lower or higher refractive errors may have a higher risk of developing dry eye symptoms.

Other factors that can increase the risk of postoperative complications to include:

  • keratoconus (a disease causing 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 symptoms aren’t well controlled, may have a more possibilities to develop complications and may not be suitable candidates for LASIK.

Find out about diabetic retinopathy here.

It is common for a person to experience symptoms of dry eye immediately following LASIK surgery. In most people, these symptoms tend to resolve after one a few months. However, some evidence suggests that 10-40% 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.

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

  • Tears: These supplements help lubricate the surface of the cornea. Tear supplements tend to be the first treatment for dry eye, and people can buy them over the counter.
  • Anti-inflammatory agents: Symptoms of dry eye can result from inflammation of the eye, which hinders the production of tears. An eye doctor may prescribe eye drop medications such as cyclosporine (Restasis) or lifitegrast (Xiidra) to reduce inflammation.
  • Point plugs: These are small silicone or gel plugs that block the tear ducts to prevent tears from leaking out of the eye, helping the eye stay moist.
  • Autologous serum eye drops: These are custom-made eye drops made for people using their own 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 post-operative dry eye symptoms, a person should make sure they take all medications prescribed by their eye doctor and follow their instructions on how to best recover. Further steps they might reduce the risk of dry eye symptoms includes:

  • avoiding dry environments and using a humidifier
  • staying hydrated by drinking plenty of water
  • get enough sleep
  • wear wrap-around sunglasses when outside to protect your eye from any irritants

Some evidence also suggests that consuming essential fatty acids, such as omega-3 fatty acids, can reduce dry eye symptoms for some people. People can get these fatty acids by taking supplements or through foods, such as salmon and tuna.

Find out if fish oils can treat dry eyes here.

An eye doctor will perform a comprehensive eye exam to determine if 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 recommend that you get treatment and check for pre-existing dry eye as surgery can worsen symptoms.

If a person is unable to manage dry eye symptoms prior to surgery, their eye doctor may advise against LASIK surgery.

Find out about the possibility of treating dry eyes here.

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 in a similar way to LASIK by creating a small incision in the cornea. While Research is mixed, there is evidence to suggest that SMILE may have a lower risk of post-operative dry eye symptoms due to its less corneal involvement.

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 the results may not last.

A doctor can also surgically implant a phakic contact lenses 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 for some people after ICL.

Not all of these interventions are suitable for everyone and they all have specific requirements. An eye doctor will take into account a person’s medical history and the characteristics of a person’s eyes and help inform them about the best procedure.

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

Find out more about glasses and contact lenses here.

Dry eye is common after surgery and can last for several months. It is important for a person to follow their doctor’s instructions during recovery and attend 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.

LASIK is a popular and generally safe procedure that can offer 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 a pre-existing dry eye, they may not be a suitable candidate for LASIK surgery and may consider other options instead. However, if they can manage dry eye symptoms, their eye doctor can approve them for LASIK surgery.

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