Dealing With Dry Eye After Lasik Surgery

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Dry eye has been long recognized as a postoperative side effect of Lasik surgery. Studies have concluded that clinically detectable dry eye is present nearly universally following Lasik surgery, even when patients do not normally experience dry eye symptoms. There are a couple of causes of dry eye problems. First, when the corneal flap is created during the Lasik procedure, either a steel blade or a laser must cut through the corneal tissue and corneal nerves are disrupted in the process. The deeper this cut, the more likely the disruption to nerve tissue. The laser reshaping of the cornea further disrupts the nerve tissue. During the time while the nerve tissue heals and regenerates, the reflex to tear and blink is significantly diminished; thus creating the dry eye problem.

The quality and smoothness of the corneal surface and tear layer is important for quick recovery of good visual acuity. The tear layer is actually the first optical surface that light hits when it enters the eye during the Lasik procedure. If that tear layer is irregular or deficient, it can create a poorer visual image, with heightened "ghosting" or "fuzziness."

To maximize my patients' vision postoperatively, I suggest approaching the problem of dry eye with a basic regimen that includes the following:

1) A good preoperative evaluation for preexisting dry eye problems and maximizing the surface condition prior to performing Lasik
2) The usage of the Intralase FS lasers for making the initial Lasik flap rather than the steel razor blade microkeratome
3) The good use of artificial tears and gel lubricants postoperatively, even if the patient does not complain of dry eye symptoms

I also suggest that patients use cyclosporine 0.05% eye drops (Restasis) twice per day for one month postoperatively. Studies have shown that this regimen can improve visual outcomes and reduce the need for enhancements after Lasik surgery. It appears that the improved quality of the tear layer can actually improve a patients vision, so that they are less likely to feel the need for additional or touch up surgery. This not only improves the patients overall experience but decreases the possibility of any secondary side effects or complications that could occur with a second procedure, however rare that would be.

Ultimately, attention to detail with every aspect of surgery enhances the outcomes as well as patient satisfaction in the long run. That's why surgeons need to pay so much attention to new and innovative technologies and medications on every level as they are developed.


About the Author:
Dr. John Suson MD is an ophthalmologist and a clinical instructor at the Medical College of Wisconsin. Currently, Dr. Suson is in private practice with his sister at their Suson Eye Specialists clinic. Eye health and care are both a family tradition and lifelong passion for Dr. Suson.



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