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LASIK and Dry Eye

July 17, 2018

If you are considering LASIK surgery, you want to be free from your glasses or contact lenses, but developing dry eyes after LASIK can be both uncomfortable and affect your vision.  Proper planning and pretreatment of an existing dry eye condition will give you the best possible outcome.

This article is one of a series we are publishing in recognition of Dry Eye Awareness month.  Please contact us if you would like to schedule an appointment.

Almost 50 percent of LASIK patients develop dry eyes after the procedure.  The dry eye symptoms are usually mild and clear up in a few weeks. But patients at a higher risk for developing dry eyes could have severe dry eye symptoms that last for months.

If you already have dry eyes, that condition must be treated before undergoing LASIK for both the best possible outcome and to prevent your dry eye condition from becoming severe after the LASIK procedure.

In addition, the surface of dry corneas will not allow for the precise measurements needed for optimal vision correction, so treating the dry eyes and restoring your cornea surface before LASIK measurements will ensure the best outcome.

Dry Eye Risk Factors

If you have an autoimmune disease or take antidepressants, antihistamines, decongestants, or antihypertensive agents, you could be at a higher risk for dry eyes after the LASIK procedure. Your surgeon will discuss your medications and if your risk for dry eye is high, you might be a candidate for a different type of vision corrective surgery—PRK.

To ensure the best possible LASIK outcome your surgeon will take a thorough history to determine if you are at risk of developing severe dry eyes after the procedure and will also use tests to measure your tear film production and tear evaporation rate, in addition to checking for any blockages in your meibomian glands.

If you have dry eyes the tests will disclose the cause, such as tear film that evaporates too quickly or drains away too fast through your tear ducts or blocked meibomian glands that are not secreting enough of the lipid layer of your tear film.  Finding the cause of your dry eyes will allow your doctor to prescribe the correct treatment to address your dry eyes.

Why Does LASIK Cause Dry Eyes?

The LASIK procedure entails creating a corneal flap before reshaping the underlying cornea and then covering the reshaped cornea with the flap.  Since only about 50 percent of LASIK patients go on to develop dry eyes, the cause of it is uncertain, but it is believed that because creating the corneal flap cuts through some corneal nerves and causes a disruption in sensing the need for lubrication until the nerves regenerate.  

In most cases of post-LASIK dry eyes using artificial tears for a few weeks until your corneas have completely healed will take care of the problem.

In severe cases of dry eyes, punctal plugs can be used. Punctal plugs are inserted into the tear ducts to block tears from draining away too quickly. The plugs are either semi-permanent and made of silicone, or dissolvable and made of collage which lasts from a few days to several months.