LASIK & Dry Eyes

In order to achieve the best possible results, patients undergoing LASIK should take time before surgery to become familiar with the relationship between LASIK and dry eyes. Here we will discuss why eyes become dry after LASIK surgery, and what to do if dry eyes are a problem before surgery.

What Causes Dry Eyes from LASIK?

During LASIK surgery, a layer of the cornea is separated to form a flap (very much like a page of a book). This cut severs the nerves that provide sensation and respond to tearing, thus breaking the cycle of feedback required for normal tearing. To put it into simpler terms, these nerves are responsible for alerting the body when the eyes lack moisture, and when they are severed, inadequate tear production can result .

Learn more about LASIK Eye Surgery

LASIK and Dry Eyes before Surgery

Having dry eyes does not rule you out as a candidate for LASIK surgery, although it may postpone your treatment. Patients with dry eyes who wish to undergo LASIK are treated for their dry eyes prior to undergoing surgery. Some patients are advised to take flaxseed oil or fish oil for several weeks to improve their tear film (the tear film is a covering that lubricates the surface of the eye). Others are given lubricating eye drops.

A normal, healthy tear film is a requirement for a successful LASIK Eye Surgery procedure. A healthy tear film contains several components that help to protect the eye against infection, and it provides a smooth optical surface that is integral to clear vision. Before LASIK and during your consultation, your surgeon and their staff will evaluate your tear film. They may directly observe the tear film with a slit lamp biomicroscope. They may measure the quantity of tears you produce. They may use special dyes such as fluorescein, which glows under a cobalt blue light, which can tell them whether the lack of tears is harming the outermost layer of cells on the cornea. Sometimes your surgeon may order a very sophisticated test called a Lactoferrin Assay, which measures the amount of lactoferrin in the tears. The real goal is for the surgeon to be comfortable with the quantity of your tears so that you can get the best possible results.

Dry Eye Treatment before LASIK Surgery

If the surgeon determines that your tear film is inadequate, there are a number of treatment options that can help fortify your tears before your LASIK procedure—for example, the surgeon may instruct you to use lubricating drops to increase the quantity of your tears. A common practice is to insert tiny polymer plugs, called punctal plugs, into the tear ducts. This is like a plumbing solution: we close one of the drains so the little water that the tap produces stays in the sink longer rather than going into the nose via these drains. Punctal plugs can be made from silicone or collagen, and some types of punctal plugs can be left in for many weeks or months, until the quantity of tears is sufficient. Another way the surgeon can treat preoperative dry eyes is by prescribing Restasis drops, a biopharmaceutical medication that actually helps you produce more of your own tears.

During your consultation it is critical that you discuss any medications you currently use with the eye surgeon and their staff. Even if you think that they are not important (perhaps because you bought them at the pharmacy without a prescription) you MUST tell the doctor that you use them, as they may indirectly cause dry eyes before or after your LASIK procedure.

Dry Eye after LASIK surgery

Under normal circumstances, the very sensitive nerves in the cornea send signals to the lacrimal gland, which produces tears in response to dryness or irritation. During LASIK surgery, however, the surgeon prepares a thin flap under which the laser energy is applied in order to shape the cornea and eliminate your nearsightedness, farsightedness, or astigmatism. It is normal and expected that during the creation of the flap a certain number of the corneal nerves will be temporarily damaged. What does this mean?

It means that for some time after your LASIK procedure, the regular nerve impulses that ordinarily would have told the lacrimal gland to produce tears will be interrupted, which may cause dry eyes. This is a normal and expected part of the healing process after LASIK.

In order to avoid this, your surgeon will have carefully examined your tears beforehand. But every LASIK patient will need to use lubricating and moisturizing drops often after their procedure. This is normal. You must keep the eye adequately bathed in tears in order for it to heal properly, so you should use the lubricating drops provided by your surgeon many times each day. You cannot overuse them.

If there was a question about your tear film before your procedure, you may already have punctal plugs in place. This too will help keep the tear film stable and help you heal. Again, almost all LASIK patients experience some degree of dry, gritty sensation after their procedures. This is best managed by following your LASIK surgeon’s instructions on the frequent use of lubricating eye drops or other treatments.

In almost all cases dry-eye symptoms disappear within a couple of months—and sometimes within a few weeks.

Preventing Dry Eyes after LASIK

In some cases it is impossible to prevent dry eyes from developing after LASIK surgery has been preformed. To prevent dry eyes after the procedure, try to:

  • Inform your LASIK surgeon in advance of any eye problems you may have normally (for example, if you have itchy eyes due to allergies).
  • Take omega-3 fatty acids to promote healthy tear film.
  • Drink plenty of water each day.
  • Avoid alcohol, caffeine, and other substances that may cause dehydration.
  • Follow all instructions given by your eye doctor before and after the surgery.

Talking to Your Eye Doctor

  • Is there anything I can do before LASIK surgery to reduce my risk of developing dry eyes afterwards?
  • How often do you perform LASIK surgery? How many of your patients report dry eyes afterward?
  • Besides LASIK surgery, what other treatment options do I have?
  • If I develop dry eye, what treatment options will I have?
  • How long will it take after LASIK surgery for symptoms of dry eye to develop?

Did you know: 50 percent of people who undergo LASIK surgery develop dry eyes afterward?

This article was last updated on 07/2014