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Why LASIK Surgery Can Cause Dry Eyes

Dry eye is a common, uncomfortable condition that leaves the eyes itchy and stinging. Unfortunately, people who have LASIK eye surgery have an increased risk of developing dry eye, although this condition usually doesn’t last longer than a year. It is believed that around 80% of people who have LASIK will suffer from dry eye for a few weeks after undergoing the eye procedure.

At the same time, dry eye is such a common condition that many people already have it before they undergo LASIK. As such, the 80% statistics mentioned above can be somewhat confusing, as it will include those people who already had it before the procedure. Very often, people who wear contact lenses suffer from dry eye, for instance, and they are also the largest group of LASIK patients.

Why LASIK Can Cause Dry Eye

One of the reasons why LASIK can cause dry eye is because of the fact that the procedure enhances vision. The cornea is reshaped during the procedure, and this can cause a problem in the tear film. Additionally, the corneal tissue itself can be removed, which can affect the nerve fibers of the cornea, which are essential for the production of tears. Sometimes, the eye becomes less sensitive, which means it no longer triggers tear production when it needs to.

There are a number of different ways in which dry eye can be treated, luckily. Tear drops have been shown to be highly effective. Those who suffer from dry eye syndrome (keratoconjunctivitis sicca), however, will often need slightly stronger, prescription eye drops, particularly after LASIK surgery. If you already have dry eye before the procedure, you must inform the surgeon about this, although this may also be identified during screening.

Dry Eye Screening

Because dry eye after LASIK is so common, most patients are asked to go on a course of eye drops before the procedure, as well as after. This will, in most cases, reduce the discomfort afterwards and will ensure vision outcomes are as expected. As stated, the surgeon will also screen patients for dry eye as well. A number of tests can be used for this, including:

  1. The Schirmer test, during with a thin strip of special paper is place underneath the lower eyelid, which then measures current tear production.
  2. Tear breakup time, which is measured through a dye placed on the surface of the eye, allowing the surgeon to see how quickly tears are produced, in what formation, and how long they last.
  3. Imaging, which is performed using an instrument such as a keratometer, allowing the surgeon to see the tear film without having to touch the surface of the eye.

Who Will Develop Dry Eye After LASIK?

As stated, some 80% of patients report dry eye after having LASIK surgery. However, research has found that certain candidates are more at risk than others. One study performed by Houston’s Baylor College of Medicine found that people who had severe myopia, therefore needing deeper corneal tissue removal, were more at risk.

The study also found that people who did not previously have dry eye were at increased risk of developing it post-LASIK. Additionally, 25% of people still had dry eye symptoms some six months after the procedure had completed.

Other causes have also been identified, including:

  • Certain drugs, particularly antihistamines, antidepressants and blood pressure medication
  • Age, with post-menopausal women being most likely to develop dry eye
  • Sjogren’s syndrome and other auto-immune diseases
  • Living in environments (indoor or outdoor) that are unusually dry

If you do have dry eye before having LASIK, you may still be able to have the procedure completed. However, this depends on how severe the condition is. In most cases, a course of treatment will be prescribed before you can have it completed.

The table below explains how many patients report dry eye problems after LASIK, showing the types of symptoms mentioned and the types of laser categories used.

  Category of Laser
Symptom Broad Beam Scanning Spot Scanning with Eye Tracker Wavefront Guided Total
Glare 10.90% 18.00% 36.60% 11.80% 19.70%
Halos 10.30% 25.40% 24.40% 12.90% 17.50%
Problems with night driving 1.10% 22.30% 34.80% 11.20% 19.30%
Dryness 0.00% 18.70% 24.20% 21.30% 21.00%

How to Treat Dry Eye Before and After LASIK

Dry eye, whether identified before or after LASIK, can be treated. Sometimes, surgeons will recommend dry eye treatment before the procedure is completed even if the patient does not present with symptoms. This is done as a precautionary measure. Some of the recommended treatment options include:

  • Fish oil and/or flaxseed oil supplements. These help to improve the quality of the tear film.
  • Lubricating eye drops
  • Restasis or other cyclosporine prescription drugs, which enable the body to create tears. Research has also shown that cyclosporine helps the eye to return to its normal moisture levels quicker after LASIK.
  • Punctal plugs, stopping drainage channels in the eyes from draining the tears away.
  • Corticosteroids in eye drops, or other such anti-inflammatory medications.

How to Prevent Dry Eye from Happening After LASIK

A LASIK surgeon will always ask for any symptoms patients currently experience that could point to dry eye. It is also important that you are proactive and mention any sensations you have yourself, such as feeling like there is something in your eye or excessive tearing.

A number of studies have shown that supplementing with omega-3 can be beneficial in preventing dry eyes. This is because it keeps the body, including the eyes, healthy and lubricated. You can also obtain omega-3 from natural sources such as fatty fish. Drinking plenty of water to stay hydrated is equally important.

The checklist below can help with either preventing dry eye, or alleviating the symptoms if you do experience them. This list is beneficial both for those who have had LASIK eye surgery, and for those who haven’t but do experience dry eye.

  • Use lubricating, preservative-free artificial tears, which are available over the counter.
  • Drink lots of water.
  • Avoid caffeinated products, as these are diuretic and drying.
  • Use a gel lubrication before going to bed. GenTeal, for instance, is a good over the counter remedy. This gel can blur vision, which is why it is important to use them before bed, when your eyes will be closed anyway.
  • Take omega-3 supplements or eat more fatty fish.
    • See our Dry Eye Starter Kit – 2 Month Supply of The Most Potent Omega-3 + Lutein Available. No Fish Burps Guaranteed!
  • Clean your eyes with a baby shampoo eyelid scrub. Do not do this after LASIK, however, as you must avoid rubbing your eyes for at least one month.
  • Use eye drops like Endura or Soothe, which have lipid emollient lubricants included in them. This improves the stability of your tears.
  • Humidify the air in your environment with room humidifiers. Make sure these are present in every room, including your living room, bedroom and office and that they are switched on at all times.

Resources and References:

Post-LASIK Dry Eye – Dry eye after LASIK surgery. (NIH.gov)
Refractive Surgery and the Dry Eye Patient – How refractive surgeons deal with patients with dry eye. (Review of Ophthalmology)
The Incidence and Risk Factors for Developing Dry Eye After Myopic LASIK – Possibility of developing dry eye after myopic LASIK surgery. (NIH.gov)