Dry Eyes and LASIK

By Marilyn Haddrill, with contributions and
review by Robert L. Epstein, MD

Dry eyes after LASIK are so common that they occur in about half of all LASIK patients. While the condition usually is temporary and mild, significant numbers of people continue to have dry eyes for months or even years after a procedure.*

But to keep the problem in perspective, many people who seek LASIK already have dry eyes. As an example, contact lens wearers who find their lenses uncomfortable because of dry eyes may investigate LASIK as an alternative because they do not want to wear eyeglasses.

Fortunately, screening for LASIK has led to advances in dry eye detection and treatment. Many people wanting laser vision correction now have the chance of actually solving their pre-existing dry eye problem if it is addressed in the LASIK consultation.

How Does LASIK Cause Dry Eyes?

In certain cases, LASIK and other vision correction procedures can cause dry eyes after they penetrate the eye's surface and reduce corneal nerve sensitivity. When your eye then fails to sense the need for lubrication, inadequate tear production results.

Dry eyes after LASIK can cause both discomfort and less than optimal visual outcomes. For this reason, many eye surgeons now recommend that you use lubricating eye drops or other therapies to help maintain eye moisture. As a precaution, you also may be given treatments to increase eye lubrication in advance of a LASIK procedure even if you don't have any sign of dry eyes.

In some cases where dry eyes are of extra concern, corrective vision procedures that do not involve creating a thin flap on the eye's surface — such as PRK — may be recommended instead of LASIK.

Dry Eye Screening for LASIK Patients

Both the quality and the quantity of tears you produce are factors in the development of dry eyes, which also can affect healing after eye surgery.

Because eye surgeons now increasingly recognize that the best LASIK outcomes may depend on controlling dry eyes, you probably will undergo screening in advance of a procedure.

Various tests for detecting dry eyes include:

• Schirmer test: a thin strip of paper placed under the lower eyelid to measure tear production.
• Tear breakup time: placement of a small amount of dye on the eye's surface to monitor how tears are distributed and when they "break up" on the eye's surface.
• Imaging: keratometers or other instruments that provide a view of the tear film without touching the eye's surface.

While assessing you as a possible candidate for a LASIK procedure, your eye surgeon also may need to determine if you have an underlying condition that might be causing dry eyes.

Who Is Most at Risk of Having Dry Eyes After LASIK?

One Baylor College of Medicine study in Houston noted a significant risk of having dry eyes after LASIK particularly in people with higher degrees of myopia who required deeper removal of corneal tissue to reshape the eye.**

Researchers also found that LASIK generally carries significant risk for dry eyes in people who did not have the problem previously. Researchers also found that dry eye symptoms persisted in about 25 percent of LASIK patients, even at six months after a procedure.

"Dry eye occurs commonly after laser-assisted in situ keratomileusis (LASIK) surgery in patients with no history of dry eye," the Houston investigators said. "The risk of developing dry eye is correlated with the degree of preoperative myopia and the depth of laser treatment. Patients should be counseled about the risk of developing dry eye after LASIK, particularly those with high myopia."

Other causes of dry eye syndrome before or after LASIK include:

• Older age, particularly if you are female and have undergone menopause.
• Allergy medications (antihistamines), certain blood pressure medications and anti-depressants that can decrease eye moisture.
• Autoimmune diseases such as Sjogren's syndrome.
• Unusually dry climates or environments, such as a room that is highly heated or air-conditioned.

Again, having dry eyes prior to a LASIK procedure will not automatically eliminate you as a candidate. But your eye surgeon will need to consider the severity of your condition and possibility of effective treatment before recommending a procedure.

Treatment of Dry Eyes Before and After LASIK

Even if you do have a pre-existing dry eye condition, LASIK surgeons may consider treating you prior to LASIK or other procedures rather than eliminating you as a candidate.

Your eye surgeon also may treat you for dry eyes prior to a LASIK procedure as a precaution, even if your tear production ordinarily is normal.

You may be advised to take flaxseed oil or fish oil orally for several weeks before your vision correction surgery to improve your tear film. You also may need to use lubricating eye drops before and after a LASIK procedure.

Your eye surgeon may recommend prescription eye drops such as cyclosporine (Restasis) that help your body formulate tears. Cyclosporine actually has been found to quicken the recovery of corneal sensitivity after LASIK and thus return the eye to normal moisture.

Other common dry eye remedies include punctal plugs, which block tear drainage channels to increase moisture on the eye, and anti-inflammatory medications such as corticosteroids administered as eye drops.

Preventing Dry Eyes After LASIK

When meeting with your LASIK surgeon during your assessment as a candidate, make sure you mention any eye symptoms that could indicate a dry eye problem, such as a foreign body sensation or eye irritation. Even excessive tearing can indicate that you have dry eyes.

Studies indicate that taking omega-3 fatty acid supplements and eating food containing these "good fats," such as salmon, can help maintain a healthy tear film. Drinking plenty of water also can help keep your body — and your eyes — properly hydrated.

Also, make sure you have a frank discussion with your LASIK surgeon about the possibility of developing dry eyes following a procedure. Ask what specific steps can be taken in case of dry eyes to restore the eye's tear film and comfort until healing is complete.

Again, keep in mind that many dry eye symptoms following a procedure usually are relatively mild and disappear in time. However, some LASIK patients have reported severe and ongoing problems with dry eyes.

Resources:

*Advances in understanding and managing dry eye disease. American Journal of Ophthalmology. September 2008.

**The incidence and risk factors for developing dry eye after myopic LASIK. American Journal of Ophthalmology. March 2006.

Being proactive in patients with Sjogren's. EyeWorld. August 2008.

Is LASIK for me? A patient's guide to refractive surgery. American Academy of Ophthalmology Web site. October 2008.

Cyclosporine 0.05% ophthalmic preparation to aid recovery from loss of corneal sensitivity after LASIK. Journal of Refractive Surgery. April 2008.

[Page updated October 2009]