LASIK & Dry Eyes
What causes dry eyes from LASIK?
Patients undergoing LASIK should take the time to become familiar with the relationship between LASIK and Dry Eyes before surgery and LASIK and dry Eyes after surgery. In order to have the best possible results, a thorough understanding of the relationship between LASIK and Dry Eyes can be very helpful.
LASIK and Dry Eyes before surgery
Having a sufficient quantity of a normal healthy tear film is a requirement for a successful LASIK Eye Surgery procedure. A healthy tear film contains several components that actually help to protect the eye against infection under normal circumstances as well as when the eye has undergone a surgical procedure such as LASIK. Thus, having a sufficient quantity of tears is important. In addition, the tear film provides a smooth optical surface and is actually an integral part of clear vision. If your tear film is inadequate before your LASIK surgery, it is sometimes possible to get inaccurate measurements when performing corneal topography or aberrometry. These faulty measurements can certainly affect your results as well. So, in order to have the best results, you should have as normal tear film as possible. During your consultation, your LASIK surgeon and their staff will be evaluating your tear film. They may directly observe the tear film with the slit lamp biomicroscope, they may measure the quantity of tears you produce using a Shirmer Test, they may use special dyes such as one that glows under a blacklight called fluorescein, or one that can tell if the lack of tears is harming the outermost layer of cells on the cornea, called Rose Bengal. Sometimes your surgeon may order a very sophisticated test called a Lactoferrin Assay if they wish to obtain even more precise information. The real goal is for the surgeon to get a comfort level with the quantity of tears so that you can get the best results.
Dry eye treatment before LASIK surgery
If the surgeon determines that your tear film is not sufficient there are a number of treatment options that may be used to help fortify your tears before your LASIK procedure. These options include having you use moisturizing drops and lubricating drops to add to the quantity of tears you have. A common practice is to insert tiny polymer plugs, called Punctal Plugs, into the tear ducts. By blocking the drainage, it helps you retain more tears on the surface of the eye and helps to eliminate Dry Eyes. Punctal Plugs can be made from silicone or collagen and can be of different types that can be left in for many weeks or months so that the quantity of tears is sufficient. Another way the surgeon can treat preoperative Dry Eyes is by prescribing Restasis drops which are a biopharmaceutical medication that actually helps you produce more of your own tears. Any and all of these options may be used by the surgeon in order to prepare your tears for LASIK surgery in the event you have Dry Eyes beforehand.
A critical part of your consultation will be openly discussing the medications that you currently use with the eye surgeon and their staff. Even if you think that they are not important, perhaps because you bought them in the pharmacy without a prescription, you MUST tell the doctor that you use them as they may be indirectly the cause of Dry Eyes before or after your LASIK procedure. The surgeon needs to know this beforehand.
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. However, during LASIK, 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 period of time after your LASIK, the regular nerve impulses that would have ordinarily told the Lacrimal Gland to produce tears will be interrupted. This is a normal and expected part of the healing process after LASIK. It can be accompanied by Dry Eyes that result in dry, gritty and uncomfortable sensations. In order to avoid this, your surgeon will have carefully examined your tearful beforehand. But, more importantly, every LASIK patient will need to use lubricating and moisturizing drops very often after their procedure. This is normal. You must keep the eye adequately bathed in tears in order to heal properly, so that 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 have Punctal Plugs in place. This too will help keep the tear film stable to help you heal. Again, it is normal that almost all LASIK patients experience some degree of dry, gritty sensation after their procedure. This is completely normal and is best managed by following your LASIK surgeons recommendation on the frequent use of lubricating eye drops or other treatments. In almost all cases after several weeks of perhaps a couple of months, the symptoms of Dry Eyes after LASIK are no longer noticeable as your eyes have healed and your tear film returns to its normal condition.