How common is Dry eye after LASIK?

I often get asked about LASIK and dry eye, especially being a LASIK surgeon in the very dry city of Las Vegas, Nevada.  Let me be straight with you. Yes, LASIK can make dryness worse, but the good news is that the dryness is typically temporary.  In my experience, the dryness takes about a week to kick in, and is the most prevalent for the first month after the procedure. This is part of the reason it is very important to see a LASIK doctor that has a lot of experience in treating dry eye.  You will find that doctors who have completed fellowships in Cornea and Refractive surgery tend to treat a larger volume of dry eye patients than doctors who have not. This also means that we tend to be very proactive in treating it early.  

Be Wary of the Internet When Researching LASIK and Dry Eye

I remember a few days before I had PRK performed on my own eyes while I was a resident in ophthalmology, I stumbled upon a website that warned that LASIK and PRK caused serious eye dryness that was devastating and irreversible.  At the time, I was still a resident at Tufts and had not yet started my fellowship in Cornea and Refractive Surgery at UCLA at that point. Since residency training in ophthalmology focuses more on the core areas or ophthalmology such as glaucoma, cataract surgery, retinal disease, and eyelid disorders more than it does on refractive surgery, I actually had not seen that many LASIK or PRK patients at that earlier point in my training.  So, when I stumbled on this website claiming LASIK was dangerous, just days before my procedure, I was concerned.  

Fast forward 10 years and I have experienced zero issues with dryness after my PRK procedure.  There are some people who develop serious dryness after LASIK, but my experience has been that most of these people had serious dryness issues before the procedure that may have gone undiagnosed.  All patients at Las Vegas Eye Institute and other quality LASIK practices are screened for pre-existing dry eyes. It is important to realize that LASIK has been performed on millions of patients throughout the US since the FDA first approved the excimer laser in 1995, and the vast majority of these patients have experienced either short-lived dryness or no dryness at all.  

Why do people experience initial eye dryness with LASIK?  

Doctors and researchers are quite certain that the reason patients get dryness with LASIK has to do with cutting of corneal nerves during the LASIK procedure.  It is important to remember that with modern thin-flap femtosecond LASIK (the only kind performed at Las Vegas Eye Institute) we are cutting far fewer nerves than we did with LASIK performed in with a blade back in the 1990s and 2000s.  

Now it’s time for some eye anatomy.  Our cornea on average is 540 microns thick.  The original LASIK performed with a blade cut 160 microns deep into the cornea.  Our Visumax Laser is programmed to create flaps that are only 110 microns thick – a reduction of approximately 31%!  Even with the thinner flap, nerves are still being cut even if it is a huge improvement over the procedures of the past.  The good news is that corneal nerves do regrow. Studies looking at recovery of corneal sensation after the procedure show over 50% recovery in sensation by three months, approximately 80% recovery at six months, and essentially a return to baseline at one year.  Interestingly this mirrors my clinical practice where most dryness symptoms are completely gone by six months after the procedure.  

View Video

Video of creation of femtosecond LASIK flap

Why Might PRK Be Better for People with Pre-Existing Dryness?

In contrast to LASIK, the PRK procedure does not require the creation of a flap in the cornea.  Instead, a very thin layer of the cornea is removed using a very dilute alcohol solution. This means that the only nerves cut during this procedure are those that are removed during what is known as the advanced surface ablation.  This advanced surface ablation generally affects only the central 6mm of the cornea. In comparison, the flaps created by the Visumax LASIK laser are typically about 8mm in diameter for myopic ablations (our cornea is on average 12mm in diameter.)  Because of the smaller amount of nerves being cut with the PRK procedure, the dryness I see in my practice from PRK is typically minimal or nonexistent. PRK, however, does have longer recovery time and is not right for everyone so please read our LASIK page to find out more.  You can discuss whether you are a better candidate for PRK or LASIK during your initial consultation.  

What Can I Expect After LASIK?

Most people will develop some level of dryness after LASIK but interestingly patients rarely report to me that their eyes “feel dry”.  The most common presentation of dry eye is a slight drop in the crispness of vision during the first month after the procedure. On examination, we see tiny dots on the surface of the eye that we refer to as punctate epithelial erosions which are essentially tiny dry spots.  The typical treatments for this temporary dryness include:

  • Punctal plug placement (very tiny devices that retain your natural tears)
  • Preservative-free artificial tears (we like Refresh Plus for this)
  • Prolonged topical steroid therapy (eye drops)
  • High dose Omega-3 supplements

Which Patients Are More Likely to Have Issues with Eye Dryness After LASIK?

During your LASIK consultation, we will ask you some basic questions about your eye general health, as we do see an increased incidence of dry eye in patients with autoimmune diseases such as Sjogren’s Syndrome, Rheumatoid Arthritis, and Lupus.  Certain medications have also been associated with dry eye – in my experience, the biggest offenders tend to be antihistamines. The acne medication Accutane can also cause severe dryness during its use and it is not recommended to undergo LASIK while on Accutane (however LASIK can be performed after the course is completed.)  Other known risk factors for dry eye include:

  • Age over 50
  • Post-menopausal females
  • Patients with diets low in vitamin A or Omega-3 fatty acids

I Want to Know More About LASIK?  What Is the Next Step?

We recommend completing a complimentary LASIK screening evaluation.  During this evaluation, we will examine your eyes to determine not only if you are a good candidate for LASIK but also to evaluate if you have any pre-existing issues with eye dryness.  Some patients are concerned about dry eyes because they find wearing contacts uncomfortable. Fortunately, most of the time this discomfort is not due to pre-existing eye dryness but rather more often due to the irritation that comes from poor oxygen and nutrient penetration caused by wearing contact lenses.  If you would like to schedule a complimentary screening evaluation please click here.

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